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Title: Thoracic Society of Australia and New Zealand (TSANZ) position statement on chronic suppurative lung disease and bronchiectasis in children, adolescents and adults in Australia and New Zealand.
Austin Authors: Chang, Anne B;Bell, Scott C;Byrnes, Catherine A;Dawkins, Paul;Holland, Anne E ;Kennedy, Emma;King, Paul T;Laird, Pamela;Mooney, Sarah;Morgan, Lucy;Parsons, Marianne;Poot, Betty;Toombs, Maree;Torzillo, Paul J;Grimwood, Keith
Affiliation: Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia.
Department of Paediatrics, University of Auckland, Auckland, New Zealand.
Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand.
Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.
College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia.
Departments of Respiratory and Sleep Medicine and Medicine, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia.
Department Physiotherapy, Perth Children's Hospital, Perth, Western Australia, Australia.
Institute for Breathing and Sleep
Department of Respiratory Medicine at Concord and Nepean Hospitals, School of Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Representative of Parent Advisory Group, NHMRC Centre of Research Excellence in Paediatric Bronchiectasis, Cough and Airways Research Group, Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
Respiratory Department, Hutt Hospital, Te Whatu Ora Capital, Coast and Hutt Valley, Lower Hutt, New Zealand.
School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
Nganampa Health Council, Alice Springs, Northwest Territories, Australia.
School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.
Issue Date: 2-Mar-2023
Date: 2023
Publication information: Respirology (Carlton, Vic.) 2023; 28(4)
Abstract: This position statement, updated from the 2015 guidelines for managing Australian and New Zealand children/adolescents and adults with chronic suppurative lung disease (CSLD) and bronchiectasis, resulted from systematic literature searches by a multi-disciplinary team that included consumers. The main statements are: Diagnose CSLD and bronchiectasis early; this requires awareness of bronchiectasis symptoms and its co-existence with other respiratory diseases (e.g., asthma, chronic obstructive pulmonary disease). Confirm bronchiectasis with a chest computed-tomography scan, using age-appropriate protocols and criteria in children. Undertake a baseline panel of investigations. Assess baseline severity, and health impact, and develop individualized management plans that include a multi-disciplinary approach and coordinated care between healthcare providers. Employ intensive treatment to improve symptom control, reduce exacerbation frequency, preserve lung function, optimize quality-of-life and enhance survival. In children, treatment also aims to optimize lung growth and, when possible, reverse bronchiectasis. Individualize airway clearance techniques (ACTs) taught by respiratory physiotherapists, encourage regular exercise, optimize nutrition, avoid air pollutants and administer vaccines following national schedules. Treat exacerbations with 14-day antibiotic courses based upon lower airway culture results, local antibiotic susceptibility patterns, clinical severity and patient tolerance. Patients with severe exacerbations and/or not responding to outpatient therapy are hospitalized for further treatments, including intravenous antibiotics and intensive ACTs. Eradicate Pseudomonas aeruginosa when newly detected in lower airway cultures. Individualize therapy for long-term antibiotics, inhaled corticosteroids, bronchodilators and mucoactive agents. Ensure ongoing care with 6-monthly monitoring for complications and co-morbidities. Undertake optimal care of under-served peoples, and despite its challenges, delivering best-practice treatment remains the overriding aim.
DOI: 10.1111/resp.14479
ORCID: 0000-0002-1331-3706
Journal: Respirology
PubMed URL: 36863703
ISSN: 1440-1843
Type: Journal Article
Subjects: adolescents
evidence base practice
systematic review
Appears in Collections:Journal articles

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