The Bronchiectasis Toolbox—A Comprehensive Website for the Management of People with Bronchiectasis

Abstract

While the health burden of bronchiectasis is increasing worldwide, medical and physiotherapy treatment strategies have progressed significantly over the past decade. For this reason, clinicians require readily accessible current evidence based information on the management of this condition. E-learning is a suitable educational forum for the development and maintenance of professional skills, however a comprehensive, evidence based, multidisciplinary website for bronchiectasis was not available. The Bronchiectasis Toolbox at www.bronchiectasis.com.au was developed by a team of clinicians in Australia and New Zealand with extensive experience in bronchiectasis. The content of this website, based on national and international guidelines, is presented under the headings: ‘Bronchiectasis’, ‘Assessment’, ‘Physiotherapy’, ‘Indigenous’, ‘Paediatrics’, and ‘Resources’. Through a blend of multimedia resources, this website provides information to consolidate the knowledge and practical skills for health professionals caring for people with this condition. After launching in 2015 the website has received 64,549 hits from over 100 countries and the videos have been viewed 10,205 times in 89 countries. The Bronchiectasis Toolbox is a comprehensive multidisciplinary resource accessible to health professionals worldwide who manage people with bronchiectasis and is a unique solution to an educational need. Regular updates will ensure that the website continues to be relevant.

Full text

medical
sciences
Communication
The Bronchiectasis Toolbox—A Comprehensive
Website for the Management of People
with Bronchiectasis
Caroline H. Nicolson 1, *, Anne E. Holland 2and Annemarie L. Lee 2
1Physiotherapy Department, The Alfred Hospital, Melbourne, 3004, Australia
2Department of Rehabilitation, Nutrition and Sport, Alfred Health Clinical School, La Trobe University;
Melbourne, 3086, Australia a.holland@latrobe.edu.au (A.E.H.); A.Lee3@latrobe.edu.au (A.L.L.)
*Correspondence: c.nicolson@alfred.org.au
Academic Editor: Eva Polverino
Received: 12 May 2017; Accepted: 7 June 2017; Published: 12 June 2017
Abstract:
While the health burden of bronchiectasis is increasing worldwide, medical and
physiotherapy treatment strategies have progressed significantly over the past decade. For this
reason, clinicians require readily accessible current evidence based information on the management
of this condition. E-learning is a suitable educational forum for the development and maintenance
of professional skills, however a comprehensive, evidence based, multidisciplinary website for
bronchiectasis was not available. The Bronchiectasis Toolbox at www.bronchiectasis.com.au was
developed by a team of clinicians in Australia and New Zealand with extensive experience
in bronchiectasis. The content of this website, based on national and international guidelines,
is presented under the headings: ‘Bronchiectasis’, ‘Assessment’, ‘Physiotherapy’, ‘Indigenous’,
‘Paediatrics’, and ‘Resources’. Through a blend of multimedia resources, this website provides
information to consolidate the knowledge and practical skills for health professionals caring for
people with this condition. After launching in 2015 the website has received 64,549 hits from over
100 countries and the videos have been viewed 10,205 times in 89 countries. The Bronchiectasis
Toolbox is a comprehensive multidisciplinary resource accessible to health professionals worldwide
who manage people with bronchiectasis and is a unique solution to an educational need. Regular
updates will ensure that the website continues to be relevant.
Keywords:
bronchiectasis; physiotherapy; airway clearance; exercise; management; antibiotics;
indigenous health
1. Introduction
Bronchiectasis is a chronic lung disease with abnormal sputum production and recurrent infections
which can significantly reduce quality of life [
1
]. The prevalence of bronchiectasis worldwide is
variable [
2
,
3
] but is known to be significantly higher amongst the Indigenous communities in Australia,
New Zealand, and Alaska [4–6].
Physiotherapy airway clearance techniques are integral to the management of patients with
bronchiectasis. In recent years, with the rising healthcare burden of bronchiectasis [
1
], an increasing
number of treatment options for maximising sputum clearance have become available. Positive
expiratory pressure therapy, advanced breathing strategies, and inhalation therapy are frequently the
patients’ treatment of choice [
7
–
10
] and the benefits of exercise and pulmonary rehabilitation in this
population have been demonstrated [
11
,
12
]. Medical management strategies have also significantly
progressed with the introduction of new regimes such as inhaled antibiotics and macrolides for people
with bronchiectasis [
13
,
14
]. Health professionals who have not recently graduated, or who are new to
Med. Sci. 2017,5, 13; doi:10.3390/medsci5020013 www.mdpi.com/journal/medsci

Med. Sci. 2017,5, 13 2 of 7
the clinical care of people with bronchiectasis, or who practice in rural or regional centres, may have
limited training in these treatment protocols. Some health professionals may be unaware of recent
advances in management, with limited access to information regarding best practice physiotherapy
and medical care. With the health burden of bronchiectasis increasing in both the non-Indigenous and
Indigenous population worldwide, with a steady rise in hospital admissions [
15
,
16
], there is a need to
ensure the most up-to-date information is readily available to all practitioners.
Comprehensive multi-media web resources are available to support health professionals caring for
people with other chronic respiratory conditions (including chronic obstructive pulmonary disease and
asthma) [
17
,
18
]. However, such resources were not available to health professionals caring for people
with bronchiectasis. This form of E-learning is optimally suited not only to health professionals working
in remote and regional areas for distance learning but also to those employed in metropolitan regions,
including medical and physiotherapy students. It is well documented that E-learning enhances and
enables effective and flexible learning for a digital generation [
19
]. The diverse modes in which material
is presented (video, audio, and written material) is designed to cater to a range of consumers’ learning
styles, to optimally facilitate learning. The goal of this website was to bridge a recognized gap in
healthcare professional education in the multidisciplinary management of people with bronchiectasis,
by developing a state-of-the-art electronic platform of information and resources.
2. Materials and Methods
A web designer was employed to develop a logo and branding and to design the site based on
the WordPress content management system with a responsive HTML5 front end which optimizes
viewing on all platforms, including mobile devices. Multi-media resources, including videos and
photographs, were produced by a professional digital media company. Consent was provided by all
participants photographed or filmed in the videos with the exception of photographs purchased from a
public website. Indigenous Respiratory Outreach Care provided access to their Aboriginal and Torres
Strait Islander health resources. To avoid copyright issues, a graphic artist was employed to create
the required diagrams. The scripts for the airway clearance videos were written by physiotherapists
with extensive experience in the management of people with bronchiectasis and in the demonstration
and teaching of physiotherapy airway clearance techniques. The selection of these techniques was
based on the current literature of airway clearance therapy in this population [
8
–
10
,
20
,
21
] and surveys
reflecting clinical practice [22–24].
The written content of the site was developed by an ad hoc group of experienced highly
qualified healthcare professionals who have completed numerous collaborative research projects
on bronchiectasis-related issues—including exercise [
11
], nebulised medications [
10
], airway clearance
therapy [
20
,
25
], pulmonary rehabilitation [
26
,
27
], and co-morbidities in bronchiectasis [
28
] and have
contributed to national guidelines for the care of individuals with bronchiectasis [
6
]. The educational
materials were developed by the team, based on the current international [
29
] and national guidelines
for bronchiectasis [
6
] under the headings ‘Bronchiectasis’, ‘Assessment’, ‘Physiotherapy’, ‘Paediatrics’,
‘Indigenous’, and ‘Resources’ (Table 1). The Indigenous section provides information on cultural
awareness and culturally appropriate resources. It was developed, in consultation with members of
the Indigenous communities, by clinicians in Australia and New Zealand with extensive experience
in both the Aboriginal and Torres Strait Islander and Maori populations. The written material was
provided by clinicians pro bono. All material is referenced to studies in peer reviewed literature in
bronchiectasis, with relevant links to enable downloading of information as required. A home page
‘News’ section enables the regular addition of research and information relevant to bronchiectasis and
a ‘Contact Us’ section is provided to enable feedback. A legal disclaimer was included on the home
page to clarify that the site was not to be relied upon by patients as a substitute for medical advice by
their health care professional.

Med. Sci. 2017,5, 13 3 of 7
Table 1. Contents of the Bronchiectasis Toolbox.
Headings Sub Headings Content
Bronchiectasis
Bronchiectasis
Definition
Pathophysiology
Prevalence
Causes
Symptoms
Diagnosis
Importance of Diagnosis
How is it Diagnosed?
Radiology
Lung Function
Sputum Pathology
Investigations for Secondary Causes
Management
Management and Goals
Treatment Options
Identifying an Exacerbation
Action Plan
Videos of Physiotherapy Techniques
Medications for Bronchiectasis
Medications Correct Use of Medications
Order of Medications
Co-morbidities
Sinusitis
Gastro-Oesophageal Reflux
Urinary Incontinence
Musculoskeletal Issues
Living with
Bronchiectasis
Nutrition
Sleep
Travel
Prognosis
Anxiety and Depression
Assessment
Medical
Clinical Examination
Bronchiectasis Severity Index
FACED 1Score
Physiotherapy Subjective Assessment
Objective Assessment
Outcome Measures
Exacerbations
Sputum
Quality of Life Questionnaires
Lung Function
Exercise Tolerance
Physiotherapy
Principles of
Airway Clearance
Airway Clearance in the Normal Lung
Hydration and Humidification
Management Plan
Choosing a Technique
Case Study
Techniques
Videos of Physiotherapy Techniques
The Active Cycle of Breathing Technique
Forced Expiration Technique
Positive Expiratory Pressure Therapy
Oscillating Positive Expiratory Pressure Therapy
Autogenic Drainage
Gravity Assisted Drainage
Manual Techniques
Exercise
Inhalation Therapy via a Nebuliser
Why Prescribe Exercise in Bronchiectasis
Exercise Prescription

Med. Sci. 2017,5, 13 4 of 7
Table 1. Cont.
Headings Sub Headings Content
Indigenous
Cultural
Aboriginal and Torres Strait Islanders
Maori
Assessment
Medical and
Physiotherapy
Causes
Management
Action plan
Airway Clearance and Exercise
Airway Clearance Video
Resources
Useful Links
Talking Posters
Flip Charts
Posters and Pamphlets
Videos
Paediatrics
Medical
Assessment
Causes
Management
Physiotherapy
Assessment and Management
Exercise
Action Plan
Airway Clearance
Choosing the Correct Technique
Airway Clearance Video
Oscillating PEP—Bottle PEP, Acapella, Flutter
Positive Expiratory Pressure Mask
Assisted Autogenic Drainage
Forced Expiration Technique
Modified Postural Drainage
Manual Techniques
High Frequency Chest Wall Oscillation
Resources
Videos
The Active Cycle of Breathing Technique
Forced Expiration Technique
Positive Expiratory Pressure (PEP) Therapy using PARI PEP,
Mask PEP, and TheraPEP
Oscillating PEP Therapy using Acapella, Bottle PEP, Flutter
Aerobika
Autogenic Drainage
Manual Techniques
Nebuliser Therapy
Correct Use of Medications
References
Airway Clearance (other than PEP)
Bronchiectasis
Co-Morbidities
Exercise
Indigenous Health
Miscellaneous
Paediatrics
PEP Therapy
Other Resources
Useful links
Patient Handouts—Including Other Languages
Physiotherapy Assessment Forms
Action Plans
Measurement of Exercise Capacity
Purchasing Equipment
Nijmegen Questionnaire
Current Research
1
FACED score: F—forced expiratory volume, A—age, C—chronic colonisation, E—radiological
extension, D—dyspnea.

Med. Sci. 2017,5, 13 5 of 7
To maximise the exposure of the website to healthcare professionals worldwide, the Bronchiectasis
Toolbox was presented at the 1st World Bronchiectasis conference in Hannover in 2016. It was also
reviewed in the European Respiratory Society and Thoracic Society of Australia and New Zealand
newsletters in 2016. Search engine optimisation strategies were implemented for the first 18 months to
assist with prominence of the website on search engines such as Google. This included the use of ad
words and the regular addition of relevant content to the website.
3. Results
The Bronchiectasis Toolbox was launched in December 2015 at www.bronchiectasis.com.au.
In 2016, it was endorsed by the Thoracic Society of Australia and New Zealand. By May 2017 the
site had 64,549 hits from over 100 countries with the majority of users being from Australia, UK,
and USA (Figure 1). Over the same period the physiotherapy airway clearance videos had been
viewed 10,205 times in 89 countries. A Google search, using the term “bronchiectasis”, currently places
the website in first position. The airway clearance videos are being used in universities throughout
Australia as a teaching tool for undergraduate physiotherapy students. The majority of feedback from
the ‘Contact Us’ section of the website has been from patients enquiring about the management of
their condition and the purchasing of equipment which indicates that a ‘Patient’ section of the website
is desirable.
Figure 1.
Countries accessing the Bronchiectasis Toolbox. UK—United Kingdom, USA—United States
of America, NZ—New Zealand.
4. Discussion
As bronchiectasis has previously been considered an orphan disease [
30
,
31
] multidisciplinary
information on the condition and management strategies has been limited. A website which presents
information on all aspects of the condition provides a wholistic approach to the disease and its
management for clinicians in one location, an option that to date has not been available. Although
designed for health professionals (including students), clinicians can direct their patients to the
‘Resources’ section of the website to view videos of a large range of airway clearance treatment
techniques, nebuliser therapy and the correct use of medications. Health professionals can also
direct their colleagues to online videos and downloadable information on a broad selection of topics,
including the latest evidence, which has been recognised as important in the overall management of
bronchiectasis, according to the latest national [
6
] and international guidelines [
29
]. The Indigenous
resources include information on the Aboriginal and Torres Strait Islander populations in Australia.
It is hoped that an Alaskan section will be developed to be included in this section. Following feedback
from patients via the website, a ‘Patient’ section is currently being developed.

Med. Sci. 2017,5, 13 6 of 7
5. Conclusions
In conclusion, the Bronchiectasis Toolbox is a unique solution to a pressing need which has been
accessed by clinicians worldwide. Ongoing evaluation of the website will assist with the continuing
inclusion of relevant evidence based updates which will ensure that the latest information is readily
accessible in a single location, contributing to the ongoing education of health professionals caring for
this patient population.
Acknowledgments:
The authors would like to thank the health care professionals who contributed to the content
of the website.
Author Contributions:
Caroline H. Nicolson drafted the manuscript, with Anne E. Holland and Annemarie L. Lee
provided critical review.
Conflicts of Interest: The authors have no conflicts of interest to declare.
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