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Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand. A position statement from the Thoracic Society of Australia and New Zealand and the Australian Lung Foundation

Anne B Chang, Scott C Bell, Cass A Byrnes, Keith Grimwood, Peter W Holmes, Paul T King, John Kolbe, Louis I Landau, Graeme P Maguire, Malcolm I McDonald, David W Reid, Francis C Thien and Paul J Torzillo
Med J Aust 2010; 193 (6): 356-365.

Summary

  • Consensus recommendations for managing chronic suppurative lung disease (CSLD) and bronchiectasis, based on systematic reviews, were developed for Australian and New Zealand children and adults during a multidisciplinary workshop.

  • The diagnosis of bronchiectasis requires a high-resolution computed tomography scan of the chest. People with symptoms of bronchiectasis, but non-diagnostic scans, have CSLD, which may progress to radiological bronchiectasis.

  • CSLD/bronchiectasis is suspected when chronic wet cough persists beyond 8 weeks. Initial assessment requires specialist expertise. Specialist referral is also required for children who have either two or more episodes of chronic (> 4 weeks) wet cough per year that respond to antibiotics, or chest radiographic abnormalities persisting for at least 6 weeks after appropriate therapy.

  • Intensive treatment seeks to improve symptom control, reduce frequency of acute pulmonary exacerbations, preserve lung function, and maintain a good quality of life.

  • Antibiotic selection for acute infective episodes is based on results of lower airway culture, local antibiotic susceptibility patterns, clinical severity and patient tolerance. Patients whose condition does not respond promptly or adequately to oral antibiotics are hospitalised for more intensive treatments, including intravenous antibiotics.

  • Ongoing treatment requires regular and coordinated primary health care and specialist review, including monitoring for complications and comorbidities.

  • Chest physiotherapy and regular exercise should be encouraged, nutrition optimised, environmental pollutants (including tobacco smoke) avoided, and vaccines administered according to national immunisation schedules.

  • Individualised long-term use of oral or nebulised antibiotics, corticosteroids, bronchodilators and mucoactive agents may provide a benefit, but are not recommended routinely.

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  • Anne B Chang1,2
  • Scott C Bell3,4
  • Cass A Byrnes5,6
  • Keith Grimwood7,4,0
  • Peter W Holmes8
  • Paul T King8
  • John Kolbe9,6
  • Louis I Landau10,0
  • Graeme P Maguire11
  • Malcolm I McDonald12
  • David W Reid13
  • Francis C Thien14
  • Paul J Torzillo15

  • 1 Royal Children's Hospital and Queensland Children’s Medical Research Institute, Brisbane, QLD.
  • 2 Respiratory Program, Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT.
  • 3 The Prince Charles Hospital, Brisbane, QLD.
  • 4 School of Medicine, University of Queensland, Brisbane, QLD.
  • 5 Starship Children's Hospital, Auckland, NZ.
  • 6 University of Auckland, Auckland, NZ.
  • 7 Queensland Paediatric Infectious Disease Laboratory, Royal Children's Hospital, Brisbane, QLD.
  • 8 Monash Medical Centre, Melbourne, VIC.
  • 9 Auckland City Hospital, Auckland, NZ.
  • 10 Health Department of Western Australia, Perth, WA.
  • 11 School of Medicine and Dentistry, James Cook University, Cairns, QLD.
  • 12 Department of Health and Families, Darwin, NT.
  • 13 Royal Hobart Hospital, University of Tasmania, Hobart, TAS.
  • 14 Box Hill Hospital, Eastern Health, Monash University, Melbourne, VIC.
  • 15 Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW.

Correspondence: annechang@ausdoctors.net

Acknowledgements: 

The workshop was partly funded by the Queensland Children’s Medical Research Institute and National Health and Medical Research Council (NHMRC) grants 389837 and 490321. Anne Chang is funded by an NHMRC practitioner fellowship (grant 525216) and the Royal Children’s Hospital Foundation.

Competing interests:

Anne Chang is a Chief Investigator on an NHMRC grant for evaluating azithromycin for bronchiectasis in Indigenous children. Scott Bell has received funding from Boehringer Ingelheim for planning a phase III study of tiotropium in patients with cystic fibrosis. He is a Chief Investigator on an NHMRC grant application evaluating azithromycin and hypertonic saline for adults with bronchiectasis. Cass Byrnes is a Principal Investigator on a New Zealand Health Research Council grant for evaluating azithromycin for bronchiectasis in Indigenous children. She is also the Chief Investigator on a grant for a randomised controlled intervention study of children at high risk of chronic lung disease, and is on the organising committee of the annual respiratory conference sponsored by Boehringer Ingelheim. Keith Grimwood is on the advisory board in NZ for PhiD-CV (synflorix), a pneumoccocal conjugate vaccine. Keith Grimwood and Paul Torzillo are Chief Investigators on an NHMRC grant for evaluating azithromycin for bronchiectasis in Indigenous children.

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