South African Thoracic Society position statement on the management of non-cystic fibrosis bronchiectasis in adults: 2023
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Abstract
Background. Bronchiectasis is a chronic lung disorder that affects the lives of many South Africans. Post-tuberculosis (TB) bronchiectasis is an important complication of previous pulmonary TB and a common cause of bronchiectasis in South Africa (SA). No previous statements on the management of bronchiectasis in SA have been published.
Objectives. To provide a position statement that will act as a template for the management of adult patients with bronchiectasis in SA.
Methods. The South African Thoracic Society appointed an editorial committee to compile a position statement on the management of adult non-cystic fibrosis (CF) bronchiectasis in SA.
Results. A position statement addressing the management of non-CF bronchiectasis in adults in SA was compiled. This position statement covers the epidemiology, aetiology, diagnosis, investigations and various aspects of management of adult patients with non-CF bronchiectasis in SA.
Conclusion. Bronchiectasis has largely been a neglected lung condition, but new research has improved the outlook for patients. Collaboration between interprofessional team members in patient management is important. In SA, more research into the epidemiology of bronchiectasis, especially post-TB bronchiectasis and HIV-associated bronchiectasis, is required.
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References
McShane PJ, Tino G. Bronchiectasis. Chest 2019;155(4):825-833. https://doi.org/10.1016/j.chest.2018.10.027
Shteinberg M, Flume PA, Chalmers JD. Is bronchiectasis really a disease? Eur Respir Rev 2020;29(155):190051. https://doi.org/10.1183/16000617.0051-2019
King P. Pathogenesis of bronchiectasis. Paediatr Respir Rev 2011;12(2):104-110. https://doi.org/10.1016/j.prrv.2010.10.011
Flume PA, Chalmers JD, Olivier KN. Advances in bronchiectasis: Endotyping, genetics, microbiome, and disease heterogeneity. Lancet 2018;392(10150):880-890. https://doi.org/10.1016/S0140-6736(18)31767-7
Zampoli M, Morrow B, eds. The South African cystic fibrosis consensus guidelines: Fifth edition, 2017. South
African Cystic Fibrosis Association, 2017. https://sacfa.org.za/wp-content/uploads/2017_09_14_CF_Consensus_Guidelines_2017.pdf (accessed 19 March 2021).
Hill AT, Sullivan AL, Chalmers JD, et al. British Thoracic Society guideline for bronchiectasis in adults. Thorax 2019;74(Suppl 1):1-69. https://doi.org/10.1136/thoraxjnl-2018-212463
Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J 2017;50(3):1700629. https://doi.org/10.1183/13993003.00629-2017
Weycker D, Hansen GL, Seifer FD. Prevalence and incidence of noncystic fibrosis bronchiectasis among
US adults in 2013. Chron Respir Dis 2017;14(4):377-384. https://doi.org/10.1177/1479972317709649
Henkle E, Chan B, Curtis JR, Aksamit TR, Daley CL, Winthrop KL. Characteristics and health-care utilisation history of patients with bronchiectasis in US Medicare enrollees with prescription drug plans, 2006 to 2014. Chest 2018;154(6):1311-1320.
https://doi.org/10.1016/j.chest.2018.07.014
Aksamit TR, O’Donnell AE, Barker A, et al. Adult patients with bronchiectasis: A first look at the US Bronchiectasis Research Registry. Chest 2017;151(5):982-992. https://doi.org/10.1016/j.chest.2016.10.055
Quint JK, Millett ERC, Joshi M, et al. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: A population-based cohort study. Eur Respir J 2016;47(1):186-193. https://doi.org/10.1183/13993003.01033-2015
Ringshausen FC, de Roux A, Diel R, Hohmann D, Welte T, Rademacher J. Bronchiectasis in Germany: A population-based estimation of disease prevalence. Eur Respir J 2015;46(6):1805-1807. https://doi.org/10.1183/13993003.00954-2015
Dhar R, Singh S, Talwar D, et al. Bronchiectasis in India: Results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry. Lancet Glob Health 2019;7(9):e1269-e1279. https://doi.org/10.1016/S2214-109X(19)30327-4
Lin JL, Xu JF, Qu JM. Bronchiectasis in China. Ann Am Thoracic Soc 2016;13(5):609-616. https://doi.org/10.1513/AnnalsATS.201511-740PS
Chandrasekaran R, Mac Aogáin M, Chalmers JD, Elborn SJ, Chotirmall SH. Geographic variation in the aetiology, epidemiology and microbiology of bronchiectasis. BMC Pulm Med 2018;18(1):83. https://doi.org/10.1186/s12890-018-0638-0
Ferrand RA, Desai SR, Hopkins C, et al. Chronic lung disease in adolescents with delayed diagnosis of vertically acquired HIV infection. Clin Infect Dis 2012;55(1):145-152. https://doi.org/10.1093/cid/cis271
Desai SR, Nair A, Rylance J, et al. Human immunodeficiency virus-associated chronic lung disease in children and adolescents in Zimbabwe: Chest radiographic and high resolution computed tomographic findings. Clin Infect Dis 2018;66(2):274-281.
https://doi.org/10.1093/cid/cix778
Chalmers JD, Chang AB, Chotirmall SH, Dhar R, McShane PJ. Bronchiectasis. Nature Rev Dis Primers 2018;4(1):45. https://doi.org/10.1038/s41572-018-0042-3
Visser SK, Bye PTP, Fox GJ, et al. Australian adults with bronchiectasis: The first report from the Australian Bronchiectasis Registry. Respir Med 2019;155:97-103. https://doi.org/10.1016/j.rmed.2019.07.016
Lonni S, Chalmers JD, Goeminne PC, et al. Etiology of non-cystic fibrosis bronchiectasis in adults and its correlation to disease severity. Ann Am Thorac Soc 2015;12(12):1764-1770. https://doi.org/10.1513/AnnalsATS.201507-472OC
Dodd PJ, Yuen CM, Jayasooriya SM, van der Zalm MM, Seddon JA. Quantifying the global number of tuberculosis survivors: A modelling study. Lancet Infect Dis 2021;21(7):984-992. https://doi.org/10.1016/S1473-3099(20)30919-1
Ravimohan S, Kornfeld H, Weissman D, Bisson GP. Tuberculosis and lung damage: From epidemiology to pathophysiology. Eur Respir Rev 2018;27(147):170077. https://doi.org/10.1183/16000617.0077-2017
Huang HY, Chung FT, Lo CY, et al. Etiology and characteristics of patients with bronchiectasis in Taiwan: A cohort study from 2002 to 2016. BMC Pulm Med 2020;20(1):45. https://doi.org/10.1186/s12890-020-1080-7
Meghji J, Simpson H, Bertel Squire S, Mortimer K. A systematic review of the prevalence and pattern of imaging defined post-TB lung disease. PLoS ONE 2016;11(8):0161176. https://doi.org/10.1371/journal.pone.0161176
Meghji J, Lesosky M, Joekes E, et al. Patient outcomes associated with post-tuberculosis lung damage in Malawi: A prospective cohort study. Thorax 2020;75(3):269-278. https://doi.org/10.1136/thoraxjnl-2019-213808
Allwood B, van der Zalm M, Amaral A, et al. Post-tuberculosis lung health: Perspectives from the First International Symposium. Int J Tuberc Lung Dis 2020;24(8):820-828. https://doi.org/10.5588/ijtld.20.0067
Mkoko P, Naidoo S, Mbanga LC, Nomvete F, Muloiwa R, Dlamini S. Chronic lung disease and a history of tuberculosis (post-tuberculosis lung disease): Clinical features and in-hospital outcomes in a resource-limited setting with a high HIV burden. S Afr
Med J 2019;109(3):169-173. https://doi.org/10.7196/SAMJ.2019.v109i3.13366
Wang H, Ji XB, Li CW, et al. Clinical characteristics and validation of bronchiectasis severity score systems for post-tuberculosis bronchiectasis. Clin Respir J 2018;12(8):2346-2353. https://doi.org/10.1111/crj.12911
Schäfer J, Griese M, Chandrasekaran R, Chotirmall SH, Hartl D. Pathogenesis, imaging and clinical characteristics of CF and non-CF bronchiectasis. BMC Pulm Med 2018;18:79. https://doi.org/10.1186/s12890-018-0630-8
Singh A, Bhalla AS, Jana M. Bronchiectasis revisited: Imaging-based pattern approach to diagnosis. Curr Probl Diagn Radiol 2019;48(1):53-60. https://doi.org/10.1067/j.cpradiol.2017.12.001
Brody AS, Klein JS, Molina PL, Quan J, Bean JA, Wilmott RW. High-resolution computed tomography in young patients with cystic fibrosis: Distribution of abnormalities and correlation with pulmonary function tests. J Pediatr 2004;145(1):32-38. https://doi.org/10.1016/j.jpeds.2004.02.038
Tiddens HAWM, Meerburg JJ, van der Eerden MM, Ciet P. The radiological diagnosis of bronchiectasis: What’s in a name? Eur Respir Rev 2020;29(156):190120. https://doi.org/10.1183/16000617.0120-2019
Hill AT, Haworth CS, Aliberti S, et al. Pulmonary exacerbation in adults with bronchiectasis: A consensus definition for clinical research. Eur Respir J 2017;49(6):1700051. https://doi.org/10.1183/13993003.00051-2017
Chalmers J, Aliberti S, Filonenko A, et al. Characterization of the ‘frequent exacerbator phenotype’ in bronchiectasis. Am J Respir Crit Care Med 2018;197(11):1410-1420. https://doi.org/10.1164/rccm.201711-2202OC
Lee AL, Burge AT, Holland AE. Airway clearance techniques for bronchiectasis. Cochrane Database Syst Rev 2010, Issue 2. Art. No.: CD008351. https://doi.org/10.1002/14651858.CD008351
Phillips J, Lee A, Pope R, Hing W. Physiotherapists’ use of airway clearance techniques during an acute exacerbation of bronchiectasis: A survey study. Arch Physiother 2021;11(1):3. https://doi.org/10.1186/s40945-020-00097-5
Wong C, Sullivan C, Jayaram L. ELTGOL airway clearance in bronchiectasis: Laying the bricks of evidence. Eur Respir J 2018;51(1):1702232. https://doi.org/10.1183/13993003.02232-2017
O’Neill K, O’Donnell AE, Bradley JM. Airway clearance, mucoactive therapies and pulmonary rehabilitation in bronchiectasis. Respirology 2019;24(3):227-237. https://doi.org/10.1111/resp.13459
Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: Key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013;188(8):e13-e64. https://doi.
org/10.1164/rccm.201309-1634ST
Granger CL, Morris NR, Holland AE. Practical approach to establishing pulmonary rehabilitation for people with non-COPD diagnoses. Respirology 2019;24(9):879-888. https://doi.org/10.1111/resp.13562
Holland AE, Cox NS, Houchen-Wolloff L, et al. Defining modern pulmonary rehabilitation: An official American Thoracic Society Workshop report. Ann Am Thorac Soc 2021;18(5):e12-e29. https://doi.org/10.1513/AnnalsATS.202102-146ST
Ozalp O, Inal-Ince D, Cakmak A, et al. High-intensity inspiratory muscle training in bronchiectasis: A randomised controlled trial. Respirology 2019;24(3):246-253. https://doi.org/10.1111/resp.13397
Lee AL, Hill CJ, McDonald CF, Holland AE. Pulmonary rehabilitation in individuals with non-cystic fibrosis bronchiectasis: A systematic review. Arch Phys Med Rehab 2017;98(4):774-782. https://doi.org/10.1016/j.apmr.2016.05.017
Chalmers JD, Aliberti S, Blasi F. Management of bronchiectasis in adults. Eur Respir J 2015;45(5):1446-1462. https://doi.org/10.1183/09031936.00119114
Angrill J, Agustí C, de Celis R, et al. Bacterial colonisation in patients with bronchiectasis: Microbiological pattern and risk factors. Thorax 2002;57(1):15-19. https://doi.org/10.1136/thorax.57.1.15
Pasteur MC, Helliwell SM, Houghton SJ, et al. An investigation into causative factors in patients with bronchiectasis. Am J Respir Crit Care Med 2000;162(4 Pt 1):1277-1284. https://doi.org/10.1164/ajrccm.162.4.9906120
Elphick HE, Tan AA. Single versus combination intravenous antibiotic therapy for people with cystic fibrosis. Cochrane Database Syst Rev 2005, Issue 2. Art. No.: CD002007. https://doi.org/10.1002/14651858.CD002007.pub2
Araújo D, Shteinberg M, Aliberti S, et al. The independent contribution of Pseudomonas aeruginosa infection to long-term clinical outcomes in bronchiectasis. Eur Respir J 2018;51(2):1701953. https://doi.org/10.1183/13993003.01953-2017
Finch S, McDonnell MJ, Abo-Leyah H, Aliberti S, Chalmers JD. A comprehensive analysis of the impact of Pseudomonas aeruginosa colonisation on prognosis in adult bronchiectasis. Ann Am Thorac Soc 2015;12(11):1602-1611. https://doi.org/10.1513/
AnnalsATS.201506-333OC
Orriols R, Hernando R, Ferrer A, Terradas S, Montoro B. Eradication therapy against Pseudomonas aeruginosa in non-cystic fibrosis bronchiectasis. Respiration 2015;90(4):299-305. https://doi.org/10.1159/000438490
Pasteur MC, Bilton D, Hill AT; British Thoracic Society Bronchiectasis (non-CF) Guideline Group. British Thoracic Society guideline for non-CF bronchiectasis. Thorax 2010;65(Suppl 1):1-58. https://doi.org/10.1136/thx.2010.136119
Wong C, Jayaram L, Karalus N, et al. Azithromycin for prevention of exacerbations in non-cystic fibrosis bronchiectasis (EMBRACE): A randomised, double-blind, placebo-controlled trial. Lancet 2012;380(9842):660-667. https://doi.org/10.1016/
S0140-6736(12)60953-2
Kapur N, Petsky HL, Bell S, Kolbe J, Chang AB. Inhaled corticosteroids for bronchiectasis. Cochrane Database Syst Rev 2018, Issue 5. Art. No.: CD000996. https://doi.org/10.1002/14651858.CD000996.pub3
Calligaro GL, Moodley L, Symons G, Dheda K. The medical and surgical treatment of drug-resistant tuberculosis. J Thorac Dis 2014;6(3):186-195. https://doi.org/10.3978/j.issn.2072-1439.2013.11.11
Yu JA, Pomerantz M, Bishop A, Weyant MJ, Mitchell JD. Lady Windermere revisited: Treatment with thoracoscopic lobectomy/segmentectomy for right middle lobe and lingular bronchiectasis associated with non-tuberculous mycobacterial disease. Eur J Cardiothorac Surg 2011;40(3):671-675. https://doi.org/10.1016/j.ejcts.2010.12.028
Calligaro GL, Brink J, Williams P, Geldenhuys A, Sussman M, Pennel T. Lung transplantation in South Africa: Indications, outcomes and disease-specific referral guidelines. Afr J Thorac Crit Care Med 2018;24(3):118-122. https://doi.org/10.7196/
SARJ.2018.v24i3.217
Boyles TH, Brink A, Calligaro GL, et al. South African guideline for the management of community-acquired pneumonia in adults. J Thorac Dis 2017;9(6):1469-1502. https://doi.org/10.21037/jtd.2017.05.31
Van Zyl-Smit RN, Feldman C, Richards G, et al. South African Thoracic Society statement on obstructive airways disease and COVID‑19. Afr J Thorac Crit Care Med 2020;26(3):117-118. https://doi.org/10.7196/AJTCCM.2020.v26i3.111
Ameratunga R, Longhurst H, Steele R, et al. Common variable immunodeficiency disorders, T-cell responses to SARS-CoV-2 vaccines, and the risk of chronic COVID‑19. J Allergy Clin Immunol Pract 2021;9(10):3575-3583. https://doi.org/10.1016/j.jaip.2021.06.019
Salinas AF, Mortari EP, Terreri S, et al. SARS-CoV-2 vaccine induced atypical immune responses in antibody defects: Everybody does their best. J Clin Immunol 2021;41:1709-1722. https://doi.org/10.1007/s10875-021-01133-0
Kamar N, Abravanel F, Marion O, Couat C, Izopet J, del Bello A. Three doses of an mRNA Covid-19 vaccine in solid-organ transplant recipients. N Engl J Med 2021;385(7):661-662. https://doi.org/10.1056/NEJMc2108861
Arbel R, Hammerman A, Sergienko R, et al. BNT162b2 vaccine booster and mortality due to Covid-19. N Engl J Med 2021;385(26):2413-2420. https://doi.org/10.1056/NEJMoa2115624
Chalmers JD, Goeminne P, Aliberti S, et al. The bronchiectasis severity index: An international derivation and validation study. Am J Respir Crit Care Med 2014;189(5):576-585. https://doi.org/10.1164/rccm.201309-1575OC
Martinez-García MÁ, de Gracia J, Relat MV, et al. Multidimensional approach to noncystic fibrosis bronchiectasis: The FACED score. Eur Respir J 2014;43(5):1357-1367. https://doi.org/10.1183/09031936.00026313
McDonnell MJ, Aliberti S, Goeminne PC, et al. Comorbidities and the risk of mortality in patients with bronchiectasis: An international cohort study. Lancet Respir Med 2016;4(12):969-679. https://doi.org/10.1016/S2213-2600(16)30320-4
Martinez-García M, Athanazio R, Girón R, et al. Predicting high risk of exacerbations in bronchiectasis: The E-FACED score. Int J Chron Obstruct Pulmon Dis 2017;12:275-284. https://doi.org/10.2147/COPD.S121943