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Abstract
Introduction Non Cystic Fibrosis (CF) Bronchiectasis is increasingly recognised as a major cause of respiratory morbidity in the UK. Previous BTS audits have shown poor adherence to the 2010 BTS guidelines for non-CF bronchiectasis. Specialist clinics for cystic fibrosis have been shown to improve survival and quality of life in CF bronchiectasis. The majority of patients with non-CF bronchiectasis are managed in general respiratory clinics. We hypothesised that the introduction of a specialist clinic for non-CF bronchiectasis would improve compliance with the BTS 2012 standards of care for non-CF bronchiectasis.
Methods Data was collected prospectively as part of the BTS national bronchiectasis audit 2012. All patients with bronchiectasis attending an outpatient respiratory clinic in Imperial NHS Trust between 1/10/12 to 31/11/12 were eligible for inclusion. Comparison between groups was performed using fischers exact test using GraphPad Prism software.
Results Forty patients attended a specialist bronchiectasis clinic, 56 patients were reviewed in a general respiratory clinic. Patients under the care of a bronchiectasis specialist were significantly more likely to have an individualised management plan (97.4% vs. 66.0% p = 0.002), to have their sputum sent for culture when clinically stable (82.5% vs. 55.4% p = 0.0018), and be investigated for cystic fibrosis (17.9% vs. 4.9% p = 0.007). They were significantly more likely to have grown a pseudomonas, staph aureus or a gram negative bacteria in their sputum in the last 12 months (29.4% vs. 5.4%, p = 0.0036) and be treated with either oral or nebulised long term antibiotics (35.0% vs. 12.5%, p = 0.012) graph 1.
Conclusions Patients attending specialist bronchiectasis clinics were more likely to be managed according to BTS quality standards. Specialist non-CF bronchiectasis clinics may improve quality of care. Further longitudinal studies are needed to investigate if specialist clinics improve clinical outcomes.
Comparison between specialist and non specialist clinics for management of bronchiectasis