Primary care summary of the British Thoracic Society Guideline on the management of non-cystic fibrosis bronchiectasis

Department of Respiratory Medicine, Royal Infirmary and University of Edinburgh, Scotland, UK.
Primary care respiratory journal: journal of the General Practice Airways Group (Impact Factor: 2.5). 02/2011; 20(2):135-40. DOI: 10.4104/pcrj.2011.00007
Source: PubMed

ABSTRACT The British Thoracic Society (BTS) has recently published a guideline for the management of non-cystic fibrosis (non-CF) bronchiectasis in children and adults. This paper summarises the key recommendations applicable to the primary care setting. The key points are: • Think of the diagnosis of bronchiectasis in adults and children who present with a chronic productive cough or unexplained haemoptysis, and in children with asthma which responds poorly to treatment; • High resolution computed tomography (HRCT) scanning is needed to confirm the diagnosis • Sputum culture should be obtained at the start of an exacerbation prior to initiating treatment with antibiotics; Treatment should be started whilst awaiting the sputum result and should be continued for 14 days; • Patients with bronchiectasis have significant morbidity. Management in primary care is aimed at improving morbidity, and includes; patient education, treatment and monitoring, as well as appropriate referral to secondary care including assessment for long term antibiotics.

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Available from: Diana Bilton, Sep 26, 2015
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    • "The identification of microorganisms in bronchial washing fluids may assist the treatment of future complications such as hemoptysis and pneumonia, but pathogens can be also isolated by analysis of sputum samples alone in 77-88% of patients with bronchiectasis.20,22 Antibioitcs are recommended when patients with bronchiectasis have purulant sputum.23 Meanwhile, when hemoptysi is the main presentation, the additional role of bronchial washing fluid to sputum exam could be low due to relatively small amount of bacterial load. "
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    ABSTRACT: Bronchiectasis is the main cause of hemoptysis. When patients with bronchiectasis develop hemoptysis, clinicians often perform bronchoscopy and bronchial washing to obtain samples for microbiological and cytological examinations. Bronchial washing fluids were analyzed from patients with bronchiectasis who developed hemoptysis, and the clinical impacts of these analyses were examined. A retrospective observational study of patients who underwent fiberoptic bronchoscopy for hemoptysis in Seoul National University Bundang Hospital, a university affiliated tertiary referral hospital, between January 2006 and December 2010 were reviewed. Among them, patients who had bronchiectasis confirmed by computed tomography and had no definite cause of hemoptysis other than bronchiectasis were reviewed. The demographic characteristics, bronchoscopy findings, microbiological data, pathology results and clinical courses of these patients were retrospectively reviewed. A total of 130 patients were reviewed. Bacteria, non-tuberculous mycobacteria (NTM), and Mycobacterium tuberculosis were isolated from bronchial washing fluids of 29.5%, 21.3%, and 0.8% patients, respectively. Suspected causal bacteria were isolated only from bronchial washing fluid in 19 patients, but this analysis led to antibiotics change in only one patient. Of the 27 patients in whom NTM were isolated from bronchial washing fluid, none of these patients took anti-NTM medication during the median follow-up period of 505 days. Malignant cells were not identified in none of the patients. Bronchial washing is a useful method to identify microorganisms when patients with bronchiectasis develop hemoptysis. However, these results only minimally affect clinical decisions.
    Yonsei medical journal 05/2014; 55(3):739-45. DOI:10.3349/ymj.2014.55.3.739 · 1.29 Impact Factor
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    • "In many parts of sub-Saharan Africa, facilities to make an accurate diagnosis are lacking. Therefore, at present it seems logical to use guidelines recommended for management of children with non-cystic bronchiectasis [37]. "
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    Journal of the International AIDS Society 06/2013; 16(1):18633. DOI:10.7448/IAS.16.1.18633 · 5.09 Impact Factor
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    • "Off-label treatments for non-CF bronchiectasis include systemic and nebulised antibacterials, oral and inhaled mucolytics, hyperosmolar agents, bronchodilators and sputum clearance techniques [7, 8]. However, these treatments do not adequately manage the number of exacerbations that patients may experience and, in some cases, their benefits have not been investigated fully. "
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    ABSTRACT: This phase II, randomised, double-blind, multicentre study (NCT00930982) investigated the safety and efficacy of ciprofloxacin dry powder for inhalation (DPI) in patients with non-cystic fibrosis bronchiectasis. Adults who were culture positive for pre-defined potential respiratory pathogens (including Pseudomonas aeruginosa and Haemophilus influenzae) were randomised to ciprofloxacin DPI 32.5 mg or placebo administered twice daily for 28 days (with 56 days of follow-up). Bacterial density in sputum (primary end-point), pulmonary function tests, health-related quality of life and safety were monitored throughout the study. 60 subjects received ciprofloxacin DPI 32.5 mg and 64 received placebo. Subjects on ciprofloxacin DPI had a significant reduction (p<0.001) in total sputum bacterial load at the end of treatment (-3.62 log10 CFU·g−1 (range -9.78–5.02 log10 CFU·g−1)) compared with placebo (-0.27 log10 CFU·g−1 (range -7.96–5.25 log10 CFU·g−1)); the counts increased thereafter. In the ciprofloxacin DPI group, 14 (35%) out of 40 subjects reported pathogen eradication at end of treatment versus four (8%) out of 49 in the placebo group (p=0.001). No abnormal safety results were reported and rates of bronchospasm were low. Ciprofloxacin DPI 32.5 mg twice daily for 28 days was well tolerated and achieved significant reductions in total bacterial load compared with placebo in subjects with non-cystic fibrosis bronchiectasis.
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