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Abstract
Introduction and Objectives Non-CF bronchiectasis is a major cause of morbidity in the UK. 60%–80% of adults with newly diagnosed bronchiectasis have had CPC since childhood. Studies show this condition can be prevented by interventions in childhood designed to improve airway clearance and elimination of bacteria. Children with CPC/non-CF bronchiectasis are often assessed in general paediatric clinics with no physiotherapy input. A study highlighted that patients attending specialist bronchiectasis clinics are more likely to be managed according to BTS quality standards. We setup a multidisciplinary clinic with standardised care for children with chronic productive cough.
Methods We introduced a one-stop multidisciplinary (CPC) clinic, lead by a designated respiratory consultant, respiratory physiotherapist and physiologist. CPC clinic runs on a monthly basis but patients can be seen between appointments if required in the physiotherapy department. We performed targeted clinical assessment using formal clinical assessment proforma, improved airway clearance techniques by regular assessment with respiratory physiotherapist and lung function by physiologist, engaged with patient and parents by providing information leaflets and involving them in formulating an individualised action plan.
Results 22 patients are assessed in CPC clinic with 90% attendance. 15 patients have established bronchiectasis among which 6 children have a diagnosis of primary ciliary dyskinesia, 7 children have CPC. All patients attending the clinic were seen by respiratory physician, chest physiotherapist and physiologist. 91% had clinical proforma sheet completed, 100% had airway clearance assessment by physiotherapist with sputum microbiology sent in 90%. 100% of children≥5 years age had lung function performed and individualised action plan given.
Conclusions Since setting up the clinic, children with CPC are getting targeted care by a multidisciplinary team. The clinic is being extended to include children with immunodeficiency under joint care with a clinical immunologist. There will be a focussed annual review with involvement of a dietician, ENT, radiology and microbiology. Feedback from users is very positive and in the short term QoL for families has improved. However it will require long term follow-up to determine if the prognosis has also improved.
