The Thoracic Society of Australia and New Zealand has updated its recommendations on the diagnosis and treatment of bronchiectasis, saying greater awareness is needed of this under-recognised disease.

Bronchiectasis remains under-recognised and undertreated in Australia, despite being the third most common chronic respiratory disorder, according to a perspective published in the Medical Journal of Australia.

The updated position statement on chronic suppurative lung disease and bronchiectasis in children, adolescents and adults will help medical professionals in diagnosing and treating bronchiectasis.

“The 2023 TSANZ Statement seeks to increase awareness of bronchiectasis in health professionals and employs the best available evidence to support its recommendations on diagnosis, underlying causes, airway clearance, controlling infection and preventing complications,” Professor Keith Grimwood and colleagues wrote.

Professor Grimwood is a paediatric infectious diseases physician at Griffith University with a joint appointment as Professor of Infectious Diseases with Gold Coast Hospital and Health Services.

What is bronchiectasis?

Bronchiectasis is an obstructive lung disease featuring abnormal dilatation of the bronchi and is characterised by chronic cough, sputum production and recurrent respiratory infections that can have significant impact on quality of life.

In Australia, it is most commonly found in Indigenous populations in remote northern communities, with 1470 per 100 000 children aged less than 14 years and 23% of Indigenous adults undergoing computed tomography scans having evidence of bronchiectasis.

The condition has a devastating impact on life expectancy, with Indigenous Australians with bronchiectasis dying 20 years earlier than non-Indigenous adults with bronchiectasis.

In an Australian cohort study, 60% of adults referred for bronchiectasishad symptoms dating back to childhood.

Since bronchiectasis is potentially reversible if diagnosed and treated early in children, the authors hope to raise awareness of the disease with the updated statement.

“Guidelines, therefore, aim for early diagnosis and treatment to reverse mild bronchiectasis in children, thereby reducing future adult bronchiectasis while seeking to preserve lung function and quality of life in others with established disease,” Professor Keith Grimwood and colleagues wrote.

Expanding on the guidelines

The updated position statement expands on the 2015 guidelines, with modifications to 28 of the existing statements offering greater detail and explanatory comments.

The statements provide guidance for health practitioners for when to refer children to paediatric respiratory specialist services, suggested investigations for determining underlying aetiology, suggestions for antibiotic selection, and recommendations for optimising management of patients.

“Making the diagnosis is the beginning, and not the end, of the diagnostic journey,” Professor Keith Grimwood and colleagues wrote.

The update highlights the need to investigate underlying causes and comorbid conditions of bronchiectasis and emphasises the importance of providing patients with continuity of care when transitioning from paediatric to adult services.

The 2023 publication also covers emerging issues such as advising against the use of electronic cigarettes, and the potential of telehealth in maintaining equitable access to specialist services in remote areas.

Further updates in the future are expected as understanding of the disease evolves.

“Despite the growing evidence base for bronchiectasis, large knowledge gaps remain and no licensed therapies exist,” Professor Keith Grimwood and colleagues wrote.

“Consequently, guidelines often rely upon expert opinion and need regular updating.”

Read the Perspective in the Medical Journal of Australia.

Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners.

Leave a Reply

Your email address will not be published. Required fields are marked *