Medical management of bronchiectasis: more MDT would help

Patients with bronchiectasis may be missing out on some aspects of best practice care, according to a Melbourne study.

The retrospective review of 145 patients with bronchiectasis managed in the general respiratory clinic at the Royal Melbourne Hospital between 2015 and 2016 found many aspects of patient care were concordant with guidelines.

Comprehensive assessment of lung function by spirometry was available for 98% of patients.

Long-term antibiotics were appropriately limited to a minority of patients (34%) including those with indications such as frequent exacerbations and pathogenic organisms cultured in sputum.

As well, the prescription of oral corticosteroids was restricted to only 18% of patients – “almost all of whom had comorbidities requiring steroid treatment”.

However the study, published in the Internal Medicine Journal, found documentation regarding essential recommendations such as airway clearance, vaccination, sputum clearance, pulmonary rehabilitation and written action plans was relatively low.

The Bronchiectasis Severity Index (BSI) score was not documented in the medical records for any patients, however severe disease (BSI >9) was common (34-48%) when calculated retrospectively.

“Patients with severe disease (scores of ≥9) were significantly more likely to receive long term antibiotics (OR 4.1, 95% CI 2.0-8.6, p<0.001), influenza vaccination (OR 3.1, 95% CI 1.5-6.5, p=0.003), pneumococcal vaccination (OR 3.3, 95% CI 1.5-67.0, p=0.002), pulmonary rehabilitation (OR 5.3, 95% CI 2.3-12.4, p<0.001), and mucolytic therapy (OR 3.9, 95% CI 1.5-10.4, p=0.005).”