Brazilian consensus on non-cystic fibrosis bronchiectasis

Abstract

Bronchiectasis is a condition that has been increasingly diagnosed by chest HRCT. In the literature, bronchiectasis is divided into bronchiectasis secondary to cystic fibrosis and bronchiectasis not associated with cystic fibrosis, which is termed non-cystic fibrosis bronchiectasis. Many causes can lead to the development of bronchiectasis, and patients usually have chronic airway symptoms, recurrent infections, and CT abnormalities consistent with the condition. The first international guideline on the diagnosis and treatment of non-cystic fibrosis bronchiectasis was published in 2010. In Brazil, this is the first review document aimed at systematizing the knowledge that has been accumulated on the subject to date. Because there is insufficient evidence on which to base recommendations for various treatment topics, here the decision was made to prepare an expert consensus document. The Brazilian Thoracic Association Committee on Respiratory Infections summoned 10 pulmonologists with expertise in bronchiectasis in Brazil to conduct a critical assessment of the available scientific evidence and international guidelines, as well as to identify aspects that are relevant to the understanding of the heterogeneity of bronchiectasis and to its diagnostic and therapeutic management. Five broad topics were established (pathophysiology, diagnosis, monitoring of stable patients, treatment of stable patients, and management of exacerbations). After this subdivision, the topics were distributed among the authors, who conducted a nonsystematic review of the literature, giving priority to major publications in the specific areas, including original articles, review articles, and systematic reviews. The authors reviewed and commented on all topics, producing a single final document that was approved by consensus.

Characterization of the severity of dyspnea in patients with bronchiectasis: correlation with clinical, functional, and tomographic aspects

“… 7 - 9 More recently, the Brazilian Thoracic Association issued a consensus statement on non-cystic fibrosis bronchiectasis in Brazil. 10 At least some of the differences across guidelines can be explained by the wide variability in the clinical characteristics of the populations studied in different countries. In a recent study conducted in Latin America, 11 the long-term clinical outcomes were similar to those reported in studies conducted in Europe and in the United States.…”

“…In addition, those studies are commonly based on European cohorts classically experiencing bronchiectasis that is less severe than that found in Latin American populations. 10 , 12 , 22 In the present study, we describe an in-depth assessment of lung function in a sample of individuals diagnosed with bronchiectasis in Brazil. The objective of the present study was to correlate clinical, functional, and radiological parameters with the severity of dyspnea in these individuals in order to determine which ones are most strongly associated with it.…”

Respiratory physiotherapy in the bronchiectasis guidelines: is there a loud voice we are yet to hear?

“…The guidelines universally recommend that patients with bronchiectasis should be taught, and should practise, individualised airway clearance techniques and that this is best delivered by a respiratory physiotherapist (table 2). The grade of relevant recommendations ranges from weak (ERS, BTS) to strong (SEPAR, TSANZ) and the quality of relevant evidence is rated as low (SEPAR, ERS, BTS, STS) to moderate (BTS, TSANZ) [16][17][18][19][20][21]. Overall, airway clearance techniques show a short-term improvement in quality of life, cough-related measures and sputum volume expectoration compared to sham intervention and inactive control groups [22,23].…”

“…Mucoactive treatments (expectorants, mucolytics, mucokinetics and mucoregulators) are also discussed in all bronchiectasis guidelines (table 2) [16][17][18][19][20][21]. These suggest offering long-term (⩾3 months) muco-active treatment in patients with difficulty expectorating sputum when standard airway clearance techniques are not adequate to control symptoms, rather than routinely.…”

“…There is a unanimously strong (ERS, SEPAR, TSANZ, BTS) recommendation for participating in pulmonary rehabilitation programmes when patients present impaired exercise capacity or report exercise limitation due to breathlessness (table 2). This recommendation was supported by moderate (TSANZ, SEPAR, STS) to high (ERS, BTS) quality of evidence [16][17][18][19][20][21]. When defined, exercise limitation due to breathlessness is indicated by a modified Medical Research Council dyspnoea scale score of ⩾1, which refers to the person that gets short of breath when hurrying on level ground or walking up a slight hill, or feels breathless even more easily than that.…”