Paediatric and adult bronchiectasis: monitoring, cross-infection, role of multi-disciplinary teams and self-management plans

Navaratnam, Vidya; Forrester, Douglas L.; Eg, Kah Peng; Chang, Anne B.

Abstract

Bronchiectasis is a chronic lung disease associated with structurally abnormal bronchi; clinically manifested by a persistent wet/productive cough, airway infections and recurrent exacerbations. Early identification and treatment of acute exacerbations is an integral part of monitoring and annual review, in both adults and children, to minimise further damage due to infection and inflammation. Common modalities used to monitor disease progression include clinical signs and symptoms, frequency of exacerbations and/or number of hospital admissions, lung function (FEV1 %predicted), imaging (radiological severity of disease) and sputum microbiology (chronic infection with P. aeruginosa). There is good evidence that these monitoring tools can be used to accurately assess severity of disease and predict prognosis in terms of mortality and future hospitalisation. Other tools that are currently used in research settings such as health-related quality of life questionnaires, magnetic resonance imaging and lung clearance index can be burdensome and require additional expertise or resource, which limits their use in clinical practice. Studies have demonstrated that cross-infection, especially with P. aeruginosa between patients with bronchiectasis is possible but infrequent. This should not limit participation of patients in group activities such as pulmonary rehabilitation, and simple infection control measures should be carried out to limit the risk of cross-transmission. A multi-disciplinary approach to care which includes respiratory physicians, chest physiotherapists, nurse specialists and other allied health professionals are vital in providing holistic care. Patient education and personalised self-management plans are also important despite limited evidence it improves quality of life or frequency of exacerbations.

Citation

Navaratnam, V., Forrester, D. L., Eg, K. P., & Chang, A. B. (2018). Paediatric and adult bronchiectasis: monitoring, cross-infection, role of multi-disciplinary teams and self-management plans. Respirology, 24(2), 115-126. https://doi.org/10.1111/resp.13451

• Journal Article Type: Article
• Acceptance Date: Nov 5, 2018
• Online Publication Date: Nov 30, 2018
• Publication Date: Nov 30, 2018
• Deposit Date: Nov 5, 2018
• Publicly Available Date: Dec 1, 2019
• Journal: Respirology
• Print ISSN: 1323-7799
• Electronic ISSN: 1440-1843
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 24
• Issue: 2
• Pages: 115-126
• DOI: https://doi.org/10.1111/resp.13451
• Keywords: Non-cystic fibrosis bronchiectasis; Paediatric bronchiectasis; Cross-infection; Cross-transmission; Disease monitoring; Multi-disciplinary team; Self-management
• Public URL: https://nottingham-repository.worktribe.com/output/1225058
• Publisher URL: https://onlinelibrary.wiley.com/doi/full/10.1111/resp.13451
• Additional Information: This is the peer reviewed version of the article, which has been published in final form athttps://onlinelibrary.wiley.com/doi/full/10.1111/resp.13451 . This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.