SEPAR's voiceSpanish Guidelines on Treatment of Bronchiectasis in AdultsNormativa sobre el tratamiento de las bronquiectasias en el adulto☆,☆☆
Introduction
Non-cystic fibrosis (CF) bronchiectasis (hereinafter, bronchiectasis [BE]) is the third most common chronic inflammatory disease of the airways after asthma and chronic obstructive pulmonary disease (COPD), and is closely related to both. In 2008, the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) became the first scientific society to establish guidelines on the diagnosis and treatment of BE, including CF.1 More than 8 years later, the scientific evidence on BE has become clearer on a number of major issues, and the findings of recent studies have compelled us to publish these new guidelines, which, in order to provide the reader with more specific information, will focus solely on BE in adults. This section concerns the treatment of BE. The guidelines have been prepared with the advice of an expert in methodology. A Delphi system was used to create the list of topics, prioritizing the clinical questions (Annex 1); key clinical questions were structured according to the PICO (Patient-Intervention-Comparison-Outcome) system, and appear as an annex at the end of the manuscript (Annex 3). Finally, the certainty of the evidence and the strength of the recommendations were established following the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system (Annexes 1 and 2).
Section snippets
Treatment of the Etiology
It is important to identify BE etiologies that have specific treatment, in order to start therapy as soon as possible to control symptoms and prevent progression of lung damage (Table 1). Treatment of the underlying disease should be reviewed at each clinical assessment.1
Antibiotic Treatment of the Initial Bronchial Infection
An association has been shown between chronic bronchial Pseudomonas aeruginosa (P. aeruginosa) infection and poorer prognosis in patients with BE.2, 3, 4, 5 Based mainly on the benefit of P. aeruginosa eradication in CF,
Definition
Exacerbation is defined as an acute sustained clinical deterioration characterized by an increase in the usual cough and changes in the sputum characteristics consisting of increased purulence, volume or viscosity, which may be accompanied by an increase in dyspnea, fever, asthenia, poor general condition, anorexia, pleuritic chest pain, hemoptysis, changes in the respiratory examination, changes in the patient's usual treatment or a significant decline in lung function.
The frequency and
Care Levels
BE is a disease that requires multidisciplinary management, so all care levels should be involved.
Primary care: clinical suspicion, differential diagnosis with other airway diseases, referral to specialists for diagnosis and etiological study, prioritization of referral, monitoring of the non-severe, stable patient, and monitoring of mild–moderate exacerbations as well as mild treatment side effects.
Nursing: control of treatment adherence, assessment of tolerance, education in the use of
Follow-Up
The frequency and intensity of follow-up of patients with BE depends on their initial severity, disease progression, their follow-up center, and the healthcare resources available. Table 9 shows the recommended timing of visits and tests. In general, patients who are monitored in specialized BE clinics or units should been seen at least once every 6–12 months. More severe or unstable patients are advised to attend once every 1–3 months, with clinical and microbiological study performed at all
Conflict of Interests
Miguel Ángel Martínez has participated in training sessions sponsored by Gilead, Novartis, Glaxo, Praxis, Teva and Zambon. He has also been the principal investigator in projects funded by Praxis and Zambon, and has participated in meetings analyzing clinical trial outcomes organized by Bayer and Grifols.
Luis Máiz has participated in training sessions sponsored by Gilead, Novartis, Zambon and Praxis.
Casilda Olveira has participated in training activities or expert committees sponsored by
Acknowledgements
David Rigau. Iberoamerican Cochrane Center. Barcelona. Spain. [email protected].
Gabriel Olveira. Endocrinology and Nutrition Service, Nutrition Unit, Regional University Málaga Hospital, CIBERDEM, CIBER of Diabetes and Associated Metabolic Diseases (Instituto de Salud Carlos III), Madrid, Spain. e-mail: [email protected].
Radiology: M.a Isabel Marco Galve. Department of Radiology. Hospital de Alta Resolución de Benalmádena (E.P. Hospital Costa del Sol). Málaga. [email protected]
References (29)
- et al.
Diagnóstico y tratamiento de las bronquiectasias
Arch Bronconeumol
(2008) - et al.
Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis
Chest
(2007) - et al.
Aztreonam for inhalation solution in patients with non-cystic fibrosis bronchiectasis (AIR-BX1 and AIR-BX2): two randomized double-blind, placebo-controlled phase 3 trials
Lancet Respir Med
(2014) - et al.
Azithromycin for prevention of exacerbations in non-cystic fibrosis bronchiectasis (EMBRACE): a randomised, double-blind, placebo-controlled trial
Lancet
(2012) - et al.
Fat free mass depletion and inflammation in patients with bronchiectasis
JADA
(2012) - et al.
Spanish consensus on the prevention and treatment of Pseudomonas aeruginosa bronchial infections in cystic fibrosis patients
Arch Bronconeumol
(2015) - et al.
Multidimensional approach to non-cystic fibrosis bronchiectasis. The FACED score
Eur Respir J
(2014) - et al.
The bronchiectasis severity index. An international derivation and validation study
Am J Respir Crit Care Med
(2014) - et al.
Predicting high risk of exacerbations in bronchiectasis: the E-FACED score
Int J Chron Obstruct Pulmon Dis
(2017) - et al.
Antibiotic strategies for eradicating Pseudomonas aeruginosa in people with cystic fibrosis
Cochrane Database Syst Rev
(2017)
Eradication therapy against Pseudomonas aeruginosa in non-cystic fibrosis bronchiectasis
Respiration
Prolonged antibiotics for non-cystic fibrosis bronchiectasis in children and adults
Cochrane Database Syst Rev
Inhaled antibiotics for stable non-cystic fibrosis bronchiectasis: a systematic review
Eur Respir J
Inhaled colistin in patients with bronchiectasis and chronic Pseudomonas aeruginosa infection
Am J Respir Crit Care Med
Cited by (0)
- ☆
Please cite this article as: Martínez-García MÁ, Máiz L, Olveira C, Girón RM, de la Rosa D, Blanco M, et al. Normativa sobre el tratamiento de las bronquiectasias en el adulto. Arch Bronconeumol. 2018;54:88–98.