A Delphi Study of Pharmacotherapy for Noncystic Fibrosis Bronchiectasis

Judson, Marc A.; Chaudhry, Haroon Rashid; Compa, Damian R.; 'Donnell, Anne E. O

doi:10.1097/maj.0000000000000312

Cited by 7 publications

(5 citation statements)

References 13 publications

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“…Routine use of airway clearance measures such as hypertonic saline or oscillating positive pressure devices in stable bronchiectasis patients are recommended by most of the experts. 33 Airway clearance measures have been associated with improved quality of life among bronchiectasis patients. 34 Regular aerobic exercise in particular was shown to reduce the frequency of exacerbation in a recent randomized clinical trial.…”

Section: Management Of Bronchiectasismentioning

confidence: 99%

Nontuberculous Mycobacteria in Cystic Fibrosis and Non–Cystic Fibrosis Bronchiectasis

Park

Olivier

2015

Semin Respir Crit Care Med

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Increasing numbers of cystic fibrosis (CF) and non-CF bronchiectasis patients are affected by pulmonary nontuberculous mycobacteria (NTM) infection worldwide. Two species of NTM account for up to 95% of the pulmonary NTM infections: Mycobacterium avium complex (MAC) and Mycobacterium abscessus complex (MABSC). Diagnosis of pulmonary NTM infection is based on criteria specified in the 2007 American Thoracic Society/Infectious Disease Society of America (ATS/IDSA) guidelines. While many initial positive cultures do not progress to active NTM disease, even a single positive NTM sputum culture obtained from higher risk groups such as classic CF or older women with bronchiectasis and very low body mass index should be closely monitored for progressive disease. Macrolides remain the most effective agents available against MAC and MABSC. Infection with MABSC may be associated with worse clinical outcomes, as more than half of MABSC isolates have inducible macrolide resistance conferred by an active erm(41) gene. Of growing concern in CF is that MABSC is becoming more common than MAC, seems to target younger patients with classic CF, and is more difficult to manage, often requiring prolonged courses of intravenous antibiotics. Recurrence rates of NTM after initial successful treatment remain high, likely due to nonmodifiable risk factors raising the question of whether secondary prophylaxis is feasible. More rapid and readily available methods for detecting inducible macrolide resistance and better in vitro susceptibility testing methods for other drugs that correlate with clinical responses are needed. This is crucial to identify more effective regimens of existing drugs and for development of novel drugs for NTM infection.

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Section: Management Of Bronchiectasismentioning

confidence: 99%

Nontuberculous Mycobacteria in Cystic Fibrosis and Non–Cystic Fibrosis Bronchiectasis

Park

Olivier

2015

Semin Respir Crit Care Med

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“…13 Some mucoactive medications improve mucus clearance when used in patients with CF, but the evidence does not support the use of these medications for patients with non-CF pulmonary disease. [58][59][60][61] Novel therapies to improve mucus clearance in unique situations, such as burns and inhalation injuries, have shown promise, but the amount of evidence is small, and more investigation is necessary before making definitive recommendations. 7 The lack of high-level evidence has a significant impact on the respiratory therapist's ability to recommend for or against using inhaled medications to improve mucus clearance.…”

Section: Implications and Directions For Future Researchmentioning

confidence: 99%

AARC Clinical Practice Guideline: Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients

et al. 2015

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Aerosolized medications are used as airway clearance therapy to treat a variety of airway diseases. These guidelines were developed from a systematic review with the purpose of determining whether the use of these medications to promote airway clearance improves oxygenation and respiratory mechanics, reduces ventilator time and ICU stay, and/or resolves atelectasis/consolidation compared with usual care. Recombinant human dornase alfa should not be used in hospitalized adult and pediatric patients without cystic fibrosis. The routine use of bronchodilators to aid in secretion clearance is not recommended. The routine use of aerosolized N-acetylcysteine to improve airway clearance is not recommended. Aerosolized agents to change mucus biophysical properties or promote airway clearance are not recommended for adult or pediatric patients with neuromuscular disease, respiratory muscle weakness, or impaired cough. Mucolytics are not recommended to treat atelectasis in postoperative adult or pediatric patients, and the routine administration of bronchodilators to postoperative patients is not recommended. There is no high-level evidence related to the use of bronchodilators, mucolytics, mucokinetics, and novel therapy to promote airway clearance in these populations.

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“…A study reported that 10 experts reached consensus on antibiotic treatment for 10-14 days for acute exacerbations of noncystic fibrosis bronchiectasis. 24) The consensus was defined as >70% agreement among experts, although firm evidence was lacking. 25) In the future, establishing the appropriate duration of antibiotic use for managing exacerbations of noncystic fibrosis bronchiectasis in children and adolescents will A c c e p t e d A r t i c l e be necessary.…”

Section: Summary Of Evidencementioning

confidence: 99%

Evidence-based management guidelines for noncystic fibrosis bronchiectasis in children and adolescents

Lee,

Kim,

Jeon

et al. 2024

Clin Exp Pediatr

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Key message We suggest offering long-term macrolides to children with noncystic fibrosis bronchiectasis (conditional recommendation, moderate quality of evidence). We do not recommend the routine use of mucolytic agents, inhaled corticosteroids, or nonsteroidal anti-inflammatory drugs to prevent exacerbation of bronchiectasis in children (inconclusive, very low quality of evidence). We recommend the use of nebulized hypertonic saline to prevent exacerbations and improve the lung function of children with noncystic fibrosis bronchiectasis (weak recommendation, moderate quality of evidence).

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A Delphi Study of Pharmacotherapy for Noncystic Fibrosis Bronchiectasis

Cited by 7 publications

References 13 publications

Nontuberculous Mycobacteria in Cystic Fibrosis and Non–Cystic Fibrosis Bronchiectasis

Nontuberculous Mycobacteria in Cystic Fibrosis and Non–Cystic Fibrosis Bronchiectasis

AARC Clinical Practice Guideline: Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients

Evidence-based management guidelines for noncystic fibrosis bronchiectasis in children and adolescents

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