Both tuberculosis and bronchiectasis carry a significant burden worldwide in terms of morbidity and mortality, as well as financial, especially in the developing world. Epidemiological data for tuberculosis are now more readily available since the World Health Organisation declared it 'a global emergency' in 1993. The global prevalence of bronchiectasis, a recognized sequel of tuberculosis, is unknown, but is by no means insignificant. The pathophysiology of chronic airflow obstruction in both of these diseases is poorly understood, but it is associated with an accelerated rate of loss in pulmonary function. This article examines the global burden of tuberculosis and bronchiectasis, and focuses on the interrelation with chronic airflow obstruction.
Multidrug-resistant tuberculosis (MDR-TB, defined as resistance to at least both rifampicin and isoniazid) has become a serious problem in the United Kingdom. As it is uncommon, no one clinician has sufficient experience of it to be confident in providing the best management for the patient. The model of a centralised system of management, such as is used in the Baltic countries, would seem a suitable method to adapt to the United Kingdom. With the agreement of the relevant professional organisations, a virtual electronic expert panel, the UK Multidrug-Resistant Tuberculosis Service, has been developed. This body gives advice via a secure website on MDR-TB patients referred by e-mail by clinicians across the country managing MDR-TB cases. In the first 2 years of operation, advice was sought on 60 patients with culture-proven MDR-TB (54% of the UK total). The number of clinicians accessing the advisory service increased from 27 in 2008 to 33 in 2009. Patients of non-UK origin accounted for 90% of all cases, including all four extensively drug-resistant tuberculosis cases. A central electronic virtual committee providing advice via a secure website has proved to be practical, economical and efficient. It could provide a model for MDR-TB management in other countries and for the management of other uncommon diseases.
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