Chronic suppurative lung disease and bronchiectasis in children, adolescents and adults in Australia and New Zealand: TSANZ position statement summary

Thoracic Society of Australia and New Zealand position statement

• Child/adolescent: recurrent (> 3 episodes per year) or chronic (> 4 weeks’ duration) wet/productive cough, chronic wet/productive cough not responding to 4 weeks of antibiotics, recurrent episodes of pneumonia (≥ 3 episodes ever), severe asthma (with chronic wet/productive cough), and/or persistent lung parenchymal abnormalities on chest x‐ray (> 6 weeks)
• Adults: chronic cough, sputum production and recurrent respiratory exacerbations, suggestive of the bronchiectasis phenotype, in patients with severe underlying asthma or COPD
• Child/adolescent: seek specialist advice first and use paediatric‐specific radiographic diagnostic criteria
• All age groups: MDCT scans with HRCT reconstruction
• Identify underlying causes; severity; comorbid conditions, including treatable traits; and lower airway microbiology
• Minimum baseline investigations: ‣ Child/adolescent: full blood count, major Ig classes (G, A, M and E), sweat test, airway cultures, spirometry if aged > 6 years ‣ Adults: full blood count, major Ig classes (G, A, M and E), airway cultures, spirometry, Aspergillus‐specific IgE if total IgE is elevated
• Child/adolescent: full blood count, major Ig classes (G, A, M and E), sweat test, airway cultures, spirometry if aged > 6 years
• Adults: full blood count, major Ig classes (G, A, M and E), airway cultures, spirometry, Aspergillus‐specific IgE if total IgE is elevated
• Additional investigations guided by history/examination findings, severity, and identifiable comorbid conditions
• Severity determined by clinical, spirometric and radiographic findings (eg, bronchiectasis severity index score for non‐Indigenous adults)
• Preserve lung function, halt disease progression, optimise symptom control and QoL, minimise frequency and severity of exacerbations, prevent complications
• Child/adolescents: in addition, optimise lung growth and possibly reverse structural lung injury
• Eradication of newly detected Pseudomonas aeruginosa
• Treatment of respiratory exacerbations
• Long term therapy to reduce exacerbation frequency in patients with the frequent exacerbator phenotype (≥ 3 episodes per year)
• Airway clearance should be individualised and reviewed regularly by a respiratory physiotherapist
• They should not be prescribed routinely, but instead on an individual basis (eg, before administering mucolytics, inhaled antibiotics or airway clearance techniques)
• They should only be used if there is an established coexisting diagnosis of asthma and/or eosinophilic airway inflammation
• Regular exercise is recommended for everyone, including with pulmonary rehabilitation in adults with frequent exacerbations and/or reduced exercise tolerance
• Optimise nutrition; avoid tobacco cigarette and electronic cigarette use and other aerotoxicants; keep up to date with vaccinations according to the national immunisation schedules, including influenza, COVID‐19 and pneumococcal vaccinations
• Patients should be reviewed at least every 6–12 months by an interdisciplinary specialist respiratory service that monitors general wellbeing, disease severity, spirometry, and airway cultures; manages treatable traits, complications and comorbid conditions; and develops individualised self‐treatment plans
• Surgery is performed rarely, but, when considered, the patient requires assessment by an expert interdisciplinary team and is undertaken in a facility able to provide the necessary pre‐ and post‐operative care
• Given the high prevalence of bronchiectasis in Indigenous people, every effort should be made to ensure that those affected receive an early diagnosis and best practice treatment — this also extends to those living in underserviced communities and in rural and remote regions of Australia
• Developmentally appropriate and planned transition from paediatric to adult health services, involving interdisciplinary teams from both services, should be provided
• COPD = chronic obstructive pulmonary disease; COVID‐19 = coronavirus disease 2019; HRCT = high resolution computed tomography; Ig = immunoglobulin; MDCT = multidetector computed tomography; QoL = quality of life; rhDNAse = recombinant human deoxyribonuclease.