Results from the Australian Bronchiectasis Registry (ABR) show a gap between guideline recommendations and real-world treatment of bronchiectasis, even in tertiary centres.

Data from 589 patients with bronchiectasis enrolled with the registry suggest that treatment is often limited by lack of access to recommended services such as pulmonary rehabiliation, according to study investigator Dr Simone Visser of the Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney.

The registry findings also suggest that more easily accessible therapies such as inhaled corticosteroids and bronchodilators are likely overused in people with bronchiectasis.

The adults with bronchiectasis enrolled on the registry from 14 tertiary hospitals across Australia since 2015 had a high severity of disease and symptom burden.

When compared with evidence-based recommendations published in the MJA in 2015, key discrepancies included:

  1. Pulmonary rehabilitation was attended by less than a quarter of patients (22%), although it was indicated in 67% of the cohort., most of whom had reduced exercise tolerance
  2. Airway clearance was undertaken in 52% of patients, although most (71%) had daily productive cough.
  3. Sputum bacterial culture results were available for 59%, and mycobacterial culture results were available for 29% of the cohort.
  4. Inhaled antibiotics were used in half of potentially eligible patients.
  5. Conversely, despite guideline recommendations against routine use, inhaled corticosteroids were used in 48% of patients.
  6. Long-term macrolides were used in 28% of participants.

“This study highlights 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,” Dr Visser and colleagues concluded in the journal Lung.

The authors said the findings should serve as a prompt to investigate barriers to patient participation in pulmonary rehabilitation and airway clearance, including access to services and equity of access when compared to cystic fibrosis-related bronchiectasis.

The results should also prompt clinicians to advocate for access to prophylactic antibiotics, and to reserve inhaled corticosteroids and bronchodilators for selected patients with concomitant asthma or COPD, they added.

“These findings encourage a review of treatment access and will inform ongoing education to promote evidence-based care for people living with bronchiectasis”.

From The Limbic – By Michael Woodhead November 2019