Diagnosing and preventing chronic suppurative lung disease (CSLD) and bronchiectasis

Abstract

Current diagnostic labelling of childhood bronchiectasis by radiology has substantial limitations. These include the requirement for two high resolution computerised tomography [HRCT] scans (with associated adversity of radiation) if criteria is adhered to, adoption of radiological criteria for children from adult data, relatively high occurrence of false negative, and to a smaller extent false positive, in conventional HRCT scans when compared to multi-detector CT scans, determination of irreversible airway dilatation, and absence of normative data on broncho-arterial ratio in children. A paradigm presenting a spectrum related to airway bacteria, with associated degradation and inflammation products causing airway damage if untreated, entails protracted bacterial bronchitis (at the mild end) to irreversible airway dilatation with cystic formation as determined by HRCT (at the severe end of the spectrum). Increasing evidence suggests that progression of airway damage can be limited by intensive treatment, even in those predestined to have bronchiectasis (eg immune deficiency). Treatment is aimed at achieving a cure in those at the milder end of the spectrum to limiting further deterioration in those with severe 'irreversible' radiological bronchiectasis.

Lung disease in indigenous children

“…Further, there is little data on long term consequences of pneumonia 38 and indigenous children have a high risk of CSLD and bronchiectasis. 4 Given the link between pneumonia and bronchiectasis, 23,39 as well as duration of chronic cough with CT bronchiectasis score and lung function decline, 44 it is good clinical practice to follow up children 3-4 weeks afterhospitalisation. They should be screened for the presence of chronic cough and persistence of other respiratory symptoms and signs (wheeze and crackles in chest auscultation).…”

Bronchiectasis: why the diagnosis shouldn't be missed in primary care

“…6 Frequent exacerbations and/or delayed treatment are clearly associated with lung function decline -itself a mortality risk -whereas there is considerable and increasing evidence that progression of airway damage can be limited with intensive medical treatment even in patients who are predestined to have bronchiectasis, such as those with immune deficiency. 7 Furthermore, in some children with bronchiectasis, resolution or considerable improvement of the changes seen on HRCT scanning of the chest have been noted, underlining the importance of early diagnosis and treatment of the condition. 5,7 It is for these reasons that early diagnosis and institution of appropriate care are essential.…”

“…7 Furthermore, in some children with bronchiectasis, resolution or considerable improvement of the changes seen on HRCT scanning of the chest have been noted, underlining the importance of early diagnosis and treatment of the condition. 5,7 It is for these reasons that early diagnosis and institution of appropriate care are essential.…”

“…2,14,15 The general aims of treatment are to limit the cycle of infection and inflammation in order to halt the progression of airway damage, to reduce symptoms and the number of exacerbations, and to improve quality of life. 1,7 The natural history of bronchiectasis and its associated mortality can be improved with expert management, with increasing evidence that early and intensive treatment can improve lung function in children and prevent deterioration, reduce respiratory exacerbations, and improve the overall long-term prognosis. 7 Primary care plays an important overall role in patient management, which should include comprehensive education for the patient about the condition and its treatment, as well as ongoing patient assessment, monitoring of therapy, and further referral to secondary care in specific circumstances.…”

“…1,7 The natural history of bronchiectasis and its associated mortality can be improved with expert management, with increasing evidence that early and intensive treatment can improve lung function in children and prevent deterioration, reduce respiratory exacerbations, and improve the overall long-term prognosis. 7 Primary care plays an important overall role in patient management, which should include comprehensive education for the patient about the condition and its treatment, as well as ongoing patient assessment, monitoring of therapy, and further referral to secondary care in specific circumstances. 9 The primary care guideline summary by Hill et al 9 gives clear indications regarding the appropriate assessment and treatment of patients with bronchiectasis, while identifying the many areas that require further research in order to clarify the issues.…”