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Title: | Management of Australian Adults with Bronchiectasis in Tertiary Care: Evidence-Based or Access-Driven?. | Authors: | Smith D.;Thomson R.M.;Stroil-Salama E.;Britton W.J.;Morgan L.C.;Visser S.K.;Bye P.T.P.;Fox G.J.;Burr L.D.;Chang A.B.;Holmes-Liew C.-L.;King P. ;Middleton P.G.;Maguire G.P. | Institution: | (Visser, Bye, Fox) Central Clinical School Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia (Visser, Bye, Fox) Department of Respiratory Medicine, Royal Prince Alfred Hospital, Level 11, Missenden Rd, Camperdown, NSW 2050, Australia (Burr) Department of Respiratory and Sleep Medicine, Mater Health, South Brisbane, QLD, Australia (Burr) Mater Research, University of Queensland, St Lucia, QLD, Australia (Chang) Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Queensland University of Technology, Brisbane, Australia (Chang) Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia (Holmes-Liew) Department of Thoracic Medicine, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia (King) Monash Respiratory and Sleep Medicine, Monash Medical Centre, Melbourne, VIC, Australia (Middleton) Department of Respiratory Medicine, Westmead Hospital, Westmead, NSW 2145, Australia (Maguire) Western Clinical School, University of Melbourne, Melbourne 3021, Australia (Maguire) General Internal Medicine, Western Health, Melbourne 3011, Australia (Smith) The Prince Charles Hospital - Thoracic Medicine, Brisbane, Australia (Smith) QIMR Berghofer Medical Research Institute - Lung Inflammation and Infection Laboratory, Herston, Australia (Thomson) Department of Respiratory Medicine, Greenslopes Private Hospital, Greenslopes, QLD 4120, Australia (Stroil-Salama) Lung Foundation Australia, Milton, QLD, Australia (Britton) Centenary Institute, The University of Sydney, Sydney, NSW 2006, Australia (Morgan) Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia (Morgan) Department of Respiratory Medicine, Concord General Repatriation Hospital, Concord, NSW 2137, Australia | Issue Date: | 28-Nov-2019 | Copyright year: | 2019 | Publisher: | Springer New York LLC | Place of publication: | United States | Publication information: | Lung. 197 (6) (pp 803-810), 2019. Date of Publication: 01 Dec 2019. | Journal: | Lung | Abstract: | Purpose: Australian data regarding the management of patients with bronchiectasis is scarce. We sought to compare the management of adults with bronchiectasis attending tertiary Australian centres with recent national and international guidelines. Method(s): The Australian Bronchiectasis Registry is a centralised database of patients with radiologically confirmed bronchiectasis unrelated to cystic fibrosis recruited from 14 tertiary Australian hospitals. We excluded children (<18 years) and those with incomplete data, leaving 589 adults for cross-sectional analyses. We compared the proportion of patients receiving certain therapies, as compared to the proportion eligible for those treatments according to the current guidelines and baseline clinical information available from the registry. Result(s): Pulmonary rehabilitation was attended by 22%, although it was indicated in 67% of the cohort. Airway clearance was undertaken in 52% of patients, although 71% reported chronic productive cough. Sputum bacterial culture results were available for 59%, and mycobacterial culture results were available for 29% of the cohort. Inhaled antibiotics were used in half of potentially eligible patients. Despite guideline recommendations against routine use, inhaled corticosteroids were used in 48% of patients. Long-term macrolides were used in 28% of participants. Conclusion(s): Discrepancies exist between guideline recommendations and real-world treatment of bronchiectasis in Australia, even in tertiary centres. These findings suggest the need for increased patient referral to pulmonary rehabilitation, increased attention to airway clearance, increased collection of sputum samples (especially for mycobacterial culture) and rationalisation of inhaled corticosteroid use. These findings encourage a review of treatment access and will inform ongoing education to promote evidence-based care for people living with bronchiectasis.Copyright © 2019, Springer Science+Business Media, LLC, part of Springer Nature. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1007/s00408-019-00280-x | PubMed URL: | 31691027 [http://www.ncbi.nlm.nih.gov/pubmed/?term=31691027] | ISSN: | 0341-2040 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/35857 | Type: | Article | Subjects: | tertiary health care aminoglycoside/dt [Drug Therapy] aminoglycoside/pv [Special Situation for Pharmacovigilance] antibiotic agent/dt [Drug Therapy] antibiotic agent/ih [Inhalational Drug Administration] antibiotic agent/po [Oral Drug Administration] antibiotic agent/pv [Special Situation for Pharmacovigilance] azithromycin/dt [Drug Therapy] azithromycin/pv [Special Situation for Pharmacovigilance] clarithromycin/dt [Drug Therapy] clarithromycin/pv [Special Situation for Pharmacovigilance] colistin/dt [Drug Therapy] colistin/pv [Special Situation for Pharmacovigilance] corticosteroid/dt [Drug Therapy] corticosteroid/ih [Inhalational Drug Administration] corticosteroid/pv [Special Situation for Pharmacovigilance] erythromycin/dt [Drug Therapy] erythromycin/pv [Special Situation for Pharmacovigilance] roxithromycin/dt [Drug Therapy] roxithromycin/pv [Special Situation for Pharmacovigilance] tetracycline/dt [Drug Therapy] tetracycline/pv [Special Situation for Pharmacovigilance] chronic productive cough male cystic fibrosis drug use evidence based practice female human lung clearance major clinical study adult aged antibiotic therapy article Australia Australian bacterium culture *bronchiectasis/dt [Drug Therapy] chronic cough cohort analysis corticosteroid therapy cross-sectional study multicenter study observational study practice guideline priority journal prospective study pulmonary rehabilitation sputum culture corticosteroid therapy cross-sectional study cystic fibrosis drug use evidence based practice female human lung clearance major clinical study male multicenter study observational study practice guideline priority journal prospective study pulmonary rehabilitation adult tertiary health care sputum culture aged antibiotic therapy Article Australia Australian bacterium culture *bronchiectasis / *drug therapy chronic cough cohort analysis |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
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