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Clinical challenges in diagnosing and managing respiratory infection
P238 Characteristics, treatment patterns and outcomes of patients with non-CF bronchiectasis: a single institution district general hospital (DGH) analysis
  1. M J McDonnell,
  2. C Mashamba,
  3. A Foden
  1. County Durham and Darlington NHS Foundation Trust, Darlington, Tyne and Wear, UK

Abstract

Introduction Non-CF bronchiectasis has been the subject of analysis for several years with limited guidelines available regarding appropriate investigation and management strategies to optimise patient care. Non-CF bronchiectasis is common and, unlike CF, is often managed by general respiratory physicians in a DGH setting. BTS consensus, based largely on case-control series and cohort studies, has recently been published to aid clinicians in diagnosis and management.

Objectives The aim of this retrospective study is to present data on patient characteristics, treatment patterns, and treatment results in an unselected patient group with non-CF bronchiectasis over a 9-year period.

Methods From January 2000 to December 2009, we reviewed the clinical, radiological, microbiological, and physiological findings in 73 well-studied patients with proven non-CF bronchiectasis. We collected data on drug and non-drug management, including side effects and response to treatment-measured as improvement in pulmonary lung function (PFTs).

Results There was a male:female ratio of 1:2 with mean age of 51.4 years (range 3–81); 46.6% were lifetime non-smokers. Idiopathic bronchiectasis was confirmed in 54.7% patients on completion of full bronchial sepsis screen. Of the idiopathic group, 42.5% were smokers; 22.5% of these were confirmed to have COPD prior to diagnosis of bronchiectasis. HRCT confirmed diagnosis of bronchiectasis in 82.2% of patients with bibasal predominance in majority. Initial CXR was abnormal in 62.8%. PFTs documented airway obstruction in 54% of lifetime non-smokers. Smokers had greater degree of airway obstruction than non-smokers and greater number of exacerbations/patient/year. Pathologic microbial flora isolated from sputum included Haemophilus influenza and other opportunistic organisms. 17.8% patients were colonised with Pseudomonas aeruginosa and treated with prophylactic nebulised antibiotics. There was no relationship between COPD and pseudomonas colonisation. 5.5% patients were treated with prophylactic oral antibiotics. Side-effects occurred in 4.1% overall (Clostridium difficile). Factors contributing to worsening of PFTs include increased number of exacerbations/patient/year, pseudomonas colonisation and smoking status.

Conclusion We provide a comprehensive analysis of a contemporary patient population. Treatment patterns fit well in the context of current consensus based on international trials. We suggest a likely correlation between the pathophysiology of COPD and bronchiectasis which warrants further investigation with randomised controlled trials.

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