South African Thoracic Society position statement on the management of non-cystic fibrosis bronchiectasis in adults: 2023

Main Article Content

A Goolam-Mahomed
S D Maasdorp
R Barnes
H Van Aswegen
A Lupton-Smith
B Allwood
G Calligaro
C Feldman
I Kalla

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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How to Cite
1.
Goolam-Mahomed A, Maasdorp SD, Barnes R, Van Aswegen H, Lupton-Smith A, Allwood B, et al. South African Thoracic Society position statement on the management of non-cystic fibrosis bronchiectasis in adults: 2023. Afr J Thoracic Crit Care Med [Internet]. 2023 Aug. 3 [cited 2024 Dec. 12];29(2):71-80. Available from: https://samajournals.co.za/index.php/ajtccm/article/view/647
Section
Guidelines, position statements and recommendation-type articles

How to Cite

1.
Goolam-Mahomed A, Maasdorp SD, Barnes R, Van Aswegen H, Lupton-Smith A, Allwood B, et al. South African Thoracic Society position statement on the management of non-cystic fibrosis bronchiectasis in adults: 2023. Afr J Thoracic Crit Care Med [Internet]. 2023 Aug. 3 [cited 2024 Dec. 12];29(2):71-80. Available from: https://samajournals.co.za/index.php/ajtccm/article/view/647

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

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