Thoracic Society of Australia and New Zealand (TSANZ) position statement on chronic suppurative lung disease and bronchiectasis in children, adolescents and adults in Australia and New Zealand

Anne B Chang; Scott C Bell; Catherine A Byrnes; Paul Dawkins; Anne E Holland; Emma Kennedy; Paul T King; Pamela Laird; Sarah Mooney; Lucy Morgan; Marianne Parsons; Betty Poot; Maree Toombs; Paul J Torzillo; Keith Grimwood

doi:10.1111/resp.14479

Thoracic Society of Australia and New Zealand (TSANZ) position statement on chronic suppurative lung disease and bronchiectasis in children, adolescents and adults in Australia and New Zealand

Respirology. 2023 Apr;28(4):339-349. doi: 10.1111/resp.14479. Epub 2023 Mar 2.

Authors

Anne B Chang^{1

2

3}, Scott C Bell^{4

5

6}, Catherine A Byrnes^{7

8}, Paul Dawkins^{9

10}, Anne E Holland^{11

12

13}, Emma Kennedy^{14

15

16}, Paul T King¹⁷, Pamela Laird^{18

19

20}, Sarah Mooney^{9

21}, Lucy Morgan²², Marianne Parsons²³, Betty Poot^{24

25}, Maree Toombs²⁶, Paul J Torzillo^{27

28}, Keith Grimwood^{29

30}

Affiliations

¹ Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
² Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.
³ NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
⁴ Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia.
⁵ Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
⁶ Translational Research Institute, Brisbane, Queensland, Australia.
⁷ Department of Paediatrics, University of Auckland, Auckland, New Zealand.
⁸ Starship Children's Hospital, Auckland, New Zealand.
⁹ Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand.
¹⁰ University of Auckland, Auckland, New Zealand.
¹¹ Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.
¹² Central Clinical School, Monash University, Melbourne, Victoria, Australia.
¹³ Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.
¹⁴ College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia.
¹⁵ Board of Northern Territory General Practice Education Ltd, Darwin, Northern Territory, Australia.
¹⁶ Pandanus Medical NT, Millner, Northern Territory, Australia.
¹⁷ Departments of Respiratory and Sleep Medicine and Medicine, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia.
¹⁸ Department Physiotherapy, Perth Children's Hospital, Perth, Western Australia, Australia.
¹⁹ Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia.
²⁰ Department of Paediatrics, School of Medicine, University of WA, Perth, Western Australia, Australia.
²¹ School of Clinical Sciences, AUT University, Auckland, New Zealand.
²² Department of Respiratory Medicine at Concord and Nepean Hospitals, School of Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
²³ Representative of Parent Advisory Group, NHMRC Centre of Research Excellence in Paediatric Bronchiectasis, Cough and Airways Research Group, Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
²⁴ Respiratory Department, Hutt Hospital, Te Whatu Ora Capital, Coast and Hutt Valley, Lower Hutt, New Zealand.
²⁵ School of Nursing Midwifery, and Health Practice, Victoria University of Wellington, Wellington, New Zealand.
²⁶ School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
²⁷ Nganampa Health Council, Alice Springs, Northwest Territories, Australia.
²⁸ Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.
²⁹ School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.
³⁰ Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Southport, Queensland, Australia.

Abstract

This position statement, updated from the 2015 guidelines for managing Australian and New Zealand children/adolescents and adults with chronic suppurative lung disease (CSLD) and bronchiectasis, resulted from systematic literature searches by a multi-disciplinary team that included consumers. The main statements are: Diagnose CSLD and bronchiectasis early; this requires awareness of bronchiectasis symptoms and its co-existence with other respiratory diseases (e.g., asthma, chronic obstructive pulmonary disease). Confirm bronchiectasis with a chest computed-tomography scan, using age-appropriate protocols and criteria in children. Undertake a baseline panel of investigations. Assess baseline severity, and health impact, and develop individualized management plans that include a multi-disciplinary approach and coordinated care between healthcare providers. Employ intensive treatment to improve symptom control, reduce exacerbation frequency, preserve lung function, optimize quality-of-life and enhance survival. In children, treatment also aims to optimize lung growth and, when possible, reverse bronchiectasis. Individualize airway clearance techniques (ACTs) taught by respiratory physiotherapists, encourage regular exercise, optimize nutrition, avoid air pollutants and administer vaccines following national schedules. Treat exacerbations with 14-day antibiotic courses based upon lower airway culture results, local antibiotic susceptibility patterns, clinical severity and patient tolerance. Patients with severe exacerbations and/or not responding to outpatient therapy are hospitalized for further treatments, including intravenous antibiotics and intensive ACTs. Eradicate Pseudomonas aeruginosa when newly detected in lower airway cultures. Individualize therapy for long-term antibiotics, inhaled corticosteroids, bronchodilators and mucoactive agents. Ensure ongoing care with 6-monthly monitoring for complications and co-morbidities. Undertake optimal care of under-served peoples, and despite its challenges, delivering best-practice treatment remains the overriding aim.

Keywords: adolescents; adults; bronchiectasis; children; evidence base practice; systematic review.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Anti-Bacterial Agents / therapeutic use
Australia
Bronchiectasis* / drug therapy
Bronchiectasis* / therapy
Child
Humans
Lung Diseases* / drug therapy
New Zealand

Substances

Anti-Bacterial Agents