Primary care implications of the British Thoracic Society Guidelines for bronchiectasis in adults 2019

Abstract

The British Thoracic Society (BTS) Guidelines for Bronchiectasis in adults were published in January 2019, and comprise recommendations for treatment from primary to tertiary care. Here, we outline the practical implications of these guidelines for primary care practitioners. A diagnosis of bronchiectasis should be considered when a patient presents with a recurrent or persistent (>8 weeks) productive cough. A definitive diagnosis is made by using thin-section chest computed tomography (CT). Once diagnosed, patients should be initially assessed by a specialist respiratory team and a shared management plan formulated with the patient, the specialist and primary care teams. The cornerstone of primary care management is physiotherapy to improve airway sputum clearance and maximise exercise capacity, with prompt treatment of acute exacerbations with antibiotics.

Praktische Tipps zu Bronchiektasen in der Primärversorgung

“…Obwohl es in diesem Punkt keinen eindeutigen Konsens gibt, sollte eine diagnostizierte Bronchiektasie im Allgemeinen in der Sekundärversorgung oder in den schwersten oder schwierigsten Fällen in spezialisierten Abteilungen weiterverfolgt werden. Die Rolle der Primärversorgung bei der Behandlung klinisch stabiler Patienten ist jedoch absolut entscheidend, ebenso wie die Zusammenarbeit mit der Tertiärversorgung in schweren Fällen [21, 33]. Weitere wichtige Faktoren sind die mikrobiologische Überwachung und serielle Sputumuntersuchungen (wann immer möglich).…”

“…Obwohl es keinen Konsens über die Merkmale der Patienten gibt, die von den verschiedenen Versorgungsstufen profitieren könnten [36], können stabile Patienten mit Bronchiektasen im Allgemeinen in der Primärversorgung behandelt werden. Bei Patienten mit chronischen Bronchialinfektionen durch pathogene Mikroorganismen (insbesondere in Verbindung mit Komorbiditäten wie schwerem Asthma und COPD) [36, 37], mangelnder klinischer Stabilität, schwer zu behandelnden Ätiologien [22, 33] oder häufigen Exazerbationen wird jedoch eine gemeinsame Behandlung mit spezialisierten Abteilungen empfohlen. Einige praktische Ratschläge für die Behandlung von Patienten mit Bronchiektasen in der Primärversorgung könnten wie folgt lauten:…”

Practical tips in bronchiectasis for Primary Care

“…Although there is no clear consensus on this point, once bronchiectasis is diagnosed, it should generally be followed up in secondary care, or in specialized units in the most severe or difficult cases. The role of Primary Care in the management of clinically stable patients is absolutely crucial, however, as is cooperation with tertiary care in severe cases 21 , 33 . Other important factors are microbiological monitoring and serial sputum examinations (whenever possible).…”

“…Although there is no consensus on the characteristics of those patients who might benefit from different levels of care 36 , in general, stable patients with bronchiectasis can be managed in Primary Care. However, joint management with specialized units is recommended for patients with chronic bronchial infection by pathogenic microorganisms (particularly when associated with comorbidities with severe asthma and COPD) 36 , 37 , a lack of clinical stability, aetiologies that are difficult to manage 22 , 33 or frequent exacerbations. Some practical advice for the management of patients with bronchiectasis in Primary Care could be as follows: It seems obvious that some general management points concur with those applicable to other chronic airway diseases: good education about the disease and about inhalation techniques; adequate vaccination against influenza, SARS-CoV-2 and Streptococcus pneumoniae ; cessation of smoking; regular clinical visits; promotion of good health-related and dietary habits; and smooth coordination with the secondary/specialist centre if the patient needs to be referred 22 , 35 , 38 .…”

The self-management abilities test (SMAT): a tool to identify the self-management abilities of adults with bronchiectasis

“…Others have highlighted that some degree of variation on these dimensions is appropriate; thus it is necessary to tailor self-management interventions to individual patients 6 . This is particularly critical in bronchiectasis, for which treatment is variable and personalised self-management plans are recommended for all 7 . This study explored what patients must know and be able to do to safely self-manage bronchiectasis.…”