Figures
- FIGURE 1
Processes to define both experts' and patients' research priorities in bronchiectasis.
- FIGURE 2
a) Aspects of bronchiectasis found either difficult or very difficult by patients. b) Aspects of bronchiectasis found difficult or very difficult by patients in comparison with the percentage of patients who identified the same aspects as “not an issue”.
Tables
- TABLE 1
Ranking of experts' research priorities in bronchiectasis
Research priority Area of research Score 1 When and how (molecule, dose, regimen, route (intravenous, oral or inhaled/nebulised) and duration) should Pseudomonas aeruginosa be eradicated in patients with bronchiectasis, and do patients' outcomes improve after that? Acute and long-term suppressive antibiotic therapy 4.35/5 2 What are the indications and what is the optimal antibiotic therapy (dosage, how many antibiotics, type, oral versus intravenous versus inhaled/nebulised and length of therapy) for an exacerbation of bronchiectasis? Exacerbation 4.30/5 3 What are the prevalence and characteristics of microbiological colonisation, and chronic and acute infections (exacerbations and pneumonia) in patients with bronchiectasis across Europe (including bacteria, viruses, fungi, nontuberculous mycobacteria and resistant microorganisms)? Epidemiology 4.29/5 4 What are the risk factors and causes of fast progression and poor outcomes (e.g. hospitalisation, lung transplantation and mortality) in patients with bronchiectasis? Outcomes, prognosis and healthcare utilisation 4.28/5 5 What is the impact of long-term antibiotic therapy on microbial resistances? Acute and long-term suppressive antibiotic therapy 4.21/5 6 When should a long-term suppressive antibiotic therapy (either oral or inhaled/nebulised) be started in patients with bronchiectasis (according to the presence or absence of P. aeruginosa or other pathogens) and what would be end-points for efficacy? Acute and long-term suppressive antibiotic therapy 4.20/5 7 What are the key factors leading to P. aeruginosa colonisation? Microbiology and microbial diagnostics 4.16/5 8 What are the indications of oral versus inhaled/nebulised long-term suppressive antibiotic treatment? Acute and long-term suppressive antibiotic therapy 4.12/5 9 What are the best molecule, dose, regimen and duration for long-term oral antibiotic therapy in patients with bronchiectasis (according to the presence or absence of P. aeruginosa or other pathogens)? Acute and long-term suppressive antibiotic therapy 4.11/5 10 What are the causes of an exacerbation of bronchiectasis? Exacerbation 4.09/5 11 When and how (molecule, dose, regimen, route (intravenous, oral or inhaled/nebulised) and duration) should pathogens other than P. aeruginosa be eradicated in patients with bronchiectasis, and do patients' outcomes improve after that? Acute and long-term suppressive antibiotic therapy 4.08/5 12 What are the best molecule, dose, regimen and duration for long-term inhaled/nebulised antibiotic therapy in patients with bronchiectasis (according to the presence or absence of P. aeruginosa or other pathogens)? Acute and long-term suppressive antibiotic therapy 4.08/5 13 What are the baseline investigations to evaluate aetiologies in patients with bronchiectasis? Aetiology, radiology and pulmonary function tests 4.08/5 14 Do different aetiologies of bronchiectasis predetermine microbiological characteristics, and affect severity, patients' quality of life and disease progression in patients with bronchiectasis? Aetiology, radiology and pulmonary function tests 4.00/5 15 How should the severity of an exacerbation of bronchiectasis be assessed and what is its impact on long-term outcomes? Exacerbation 3.98/5 16 When should airway drainage techniques be started in patients with bronchiectasis, and which one is the most effective and pragmatic? Physiotherapy and pulmonary rehabilitation 3.97/5 17 Which is the most useful severity score in clinical practice in patients with bronchiectasis? Outcomes, prognosis and healthcare utilisation 3.96/5 18 Does an early referral to a specialist clinic change outcomes in patients with bronchiectasis? Outcomes, prognosis and healthcare utilisation 3.96/5 19 What is the average lung function decline in patients with bronchiectasis across Europe and what are the risk or protective factors for that? Aetiology, radiology and pulmonary function tests 3.93/5 20 Which factors, including aetiology of bronchiectasis, patients' characteristics or bacteria isolated in sputum, affect macrolide efficacy in patients with bronchiectasis? Acute and long-term suppressive antibiotic therapy 3.92/5 21 What are the characteristics of patients' microbiomes, both during the stable state and exacerbation, and what is its impact on severity of the disease and follow-up? Microbiology and microbial diagnostics 3.90/5 22 What is the role of viruses, atypicals, fungi and anaerobes (both singly and in co-infection) in patients with bronchiectasis, during both the stable state and exacerbation, and what is their impact of patients' severity and outcomes? Microbiology and microbial diagnostics 3.89/5 23 What is the prevalence of different aetiologies of bronchiectasis across Europe? Epidemiology 3.87/5 24 Are influenza and/or pneumococcal vaccines and other immunotherapies effective in preventing exacerbations in patients with bronchiectasis? Other 3.84/5 25 What are the adverse events of a both oral and inhaled/nebulised suppressive antibiotic therapy in patients with bronchiectasis? Acute and long-term suppressive antibiotic therapy 3.83/5 26 What are the prevalence and type of long-term suppressive oral (macrolide and nonmacrolide) and nebulised/inhaled antibiotic therapy in patients with bronchiectasis across Europe? Epidemiology 3.83/5 27 When should pulmonary rehabilitation be started in patients with bronchiectasis and what is its impact on patients' outcomes? Physiotherapy and pulmonary rehabilitation 3.82/5 28 What are incidence, prevalence, patients' demographic characteristics and comorbidities of bronchiectasis across Europe? Epidemiology 3.81/5 29 Is airway clearance useful during an acute exacerbation of bronchiectasis? Exacerbation 3.80/5 30 Should we establish new breakpoints for predicting bacteria susceptibility when inhaled/nebulised antibiotics are used? Microbiology and microbial diagnostics 3.78/5 31 What are the indications/contraindications for lung transplantation in bronchiectasis and what are patients' outcomes after lung transplantation? Other 3.73/5 32 Which are the best systemic (e.g. blood) or local (e.g. sputum) inflammatory markers for the diagnosis, management and follow-up of patients with bronchiectasis? Pathogenesis and mechanisms of the disease 3.73/5 33 What is the distribution of inhaled/nebulised antibiotics with different formulations and devices in lungs with bronchiectasis? Acute and long-term suppressive antibiotic therapy 3.73/5 34 Do specific patient education packages, self-management plans and patients support groups improve outcomes in patients with bronchiectasis? Other 3.72/5 35 Where are patients with bronchiectasis managed across Europe, including specialist (bronchiectasis) clinics, CF centres/clinics, respiratory clinics or general practitioners? Epidemiology 3.67/5 36 Are other functional tests (such as carbon monoxide diffusing capacity, 6-min walk test, lung clearance index, endurance shuttle walk, incremental exercise tests or accelerometers) markers for severity of the disease, outcomes and end-points for the clinic? Aetiology, radiology and pulmonary function tests 3.64/5 37 What is the best approach/score to evaluate radiological severity in patients with bronchiectasis? Aetiology, radiology and pulmonary function tests 3.63/5 38 Might cross-infection occur in patients with bronchiectasis and is patients segregation required? Microbiology and microbial diagnostics 3.62/5 39 What are the healthcare costs of bronchiectasis management across Europe? Epidemiology 3.60/5 40 What is the role of inhaled hyperosmolar therapy (e.g. hyaluronate; mannitol; or NaCl 3%, 6% or 7%)? Nonantibiotic and anti-inflammatory therapies 3.53/5 41 What are the radiological changes in bronchiectasis over time? Aetiology, radiology and pulmonary function tests 3.52/5 42 What is the impact of haemoptysis on the prognosis of patients with bronchiectasis and how should it be managed? Other 3.51/5 43 What are the genetic and epigenetic findings in patients with bronchiectasis compared to healthy controls, and what is their role in acquisition of specific pathogens and patients' outcomes? Pathogenesis and mech anisms of the disease 3.50/5 44 What are the characteristics and outcomes of patients with bronchiectasis undergoing surgery, including segmentectomy, lobectomy or pneumonectomy? Other 3.49/5 45 What is the role of systemic steroids during an exacerbation of bronchiectasis? Exacerbation 3.47/5 46 Is there an increased rate of innate immune defects (e.g. mannose-binding lectin deficiency, common variable immunodeficiency, IgM or IgA deficiency, or complement deficiency) in specific patients with bronchiectasis? Pathogenesis and mechanisms of the disease 3.46/5 47 What is the role of long-term inhaled corticosteroids in patients with bronchiectasis? Nonantibiotic and anti-inflammatory therapies 3.38/5 48 What are the frequency of CF heterozygosity, and the role of CFTR and ENaC dysfunction in patients with bronchiectasis? Pathogenesis and mechanisms of the disease 3.36/5 49 What is the role of oral mucolytics in patients with bronchiectasis? Nonantibiotic and anti-inflammatory therapies 3.35/5 50 What is the role of antiproteinases/elastase inhibitors in patients with bronchiectasis? Nonantibiotic and anti-inflammatory therapies 3.19/5 51 What is the role of systemic anti-inflammatory therapies (e.g. steroids or nonsteroidal anti-inflammatory drugs) during the stable state in patients with bronchiectasis? Nonantibiotic and anti-inflammatory therapies 3.15/5 52 What is the role of protease–antiprotease imbalance, matrix metalloproteinase and neuron-specific enolase in patients with bronchiectasis? Pathogenesis and mechanisms of the disease 3.14/5 53 What is the role of anticholinergic therapy in patients with bronchiectasis? Nonantibiotic and anti-inflammatory therapies 3.12/5 54 What is the role of phosphodiesterase type 4 inhibitors in patients with bronchiectasis? Nonantibiotic and anti-inflammatory therapies 2.97/5 55 Does daily proton-pump inhibitor use impact clinical outcomes in patients with bronchiectasis? Nonantibiotic and anti-inflammatory therapies 2.96/5 CF: cystic fibrosis; CFTR: cystic fibrosis transmembrane conductance regulator; ENaC: epithelial sodium channel.
- TABLE 2
Ranking of patients' and carers' research priorities in bronchiectasis
Research priority Area of research 1 How does bronchiectasis develop and continue? How bronchiectasis is managed by doctors 2 How can communication between healthcare professionals and each patient be optimised to improve self-management? Self-management by patients 3 What makes some patients get worse? How bronchiectasis is managed by doctors 4 What are causes of bronchiectasis? How bronchiectasis is managed by doctors 5 What are the triggers for an exacerbation? How bronchiectasis is managed by doctors 6 How can self-management programmes and care plans designed with each person be most effective in helping patients have greater control over their condition and recognise/manage an exacerbation? Self-management by patients 7 How can physiotherapy be accessible to all patients, and teach them to use the techniques and how to use the equipment at home effectively? Self-management by patients 8 How can reliable, plain language information on living with bronchiectasis be accessible to patients? Self-management by patients 9 How can patients at increased risk of poor outcomes or needing urgent treatment be identified? How each person's bronchiectasis is monitored 10 How can awareness of bronchiectasis in community care services be improved (e.g. among community-based nurses and physiotherapists)? How bronchiectasis is treated 11 Are there ways to diagnose bronchiectasis earlier? How bronchiectasis is managed by doctors 12 How can awareness of the role of physiotherapy and pulmonary rehabilitation in treating bronchiectasis be improved? How bronchiectasis is treated 13 Can we test new techniques for managing bronchiectasis in real-world environments, such as at home and community settings (not in the laboratory or in hospitals), to improve how bronchiectasis is managed? How bronchiectasis is managed by doctors 14 Is there a link between getting a cold and exacerbation? How bronchiectasis is managed by doctors 15 Can regular lung function testing help notice changes or increased risk of an exacerbation? How each person's bronchiectasis is monitored 16 Is there a relationship between bronchiectasis and other conditions, such as asthma, “acid” reflux and inflammatory bowel diseases? How bronchiectasis is managed by doctors 17 Can new medicines that can be taken in new ways be developed (e.g. inhaled or nebulised)? How bronchiectasis is treated 18 Can regular sputum examinations when a person is stable and during exacerbation help us learn more about how the condition changes? How each person's bronchiectasis is monitored 19 Can we develop better ways of teaching people to use their medicines? How bronchiectasis is treated 20 Can we provide and will providing test results help each patient follow their progress? Self-management by patients 21 How can primary care doctors be educated to prescribe the same dose/length of antibiotic therapy for exacerbations in bronchiectasis as used in CF? How bronchiectasis is treated 22 Can vaccines be developed/used to prevent exacerbations? How bronchiectasis is treated 23 How often/why does bronchiectasis occurs in certain groups of people? How bronchiectasis is managed by doctors 24 How can we ensure that each person has access to a home intravenous antibiotic service to avoid unnecessary hospital admissions? Self-management by patients 25 How can awareness, and use of peer support forums and social media to exchange information be raised? Self-management by patients 26 How can patients have and use equipment at home to monitor their symptoms? How each person's bronchiectasis is monitored 27 How can the monitoring and treatment of coughing up blood be achieved? How each person's bronchiectasis is monitored 28 Can using longer-term antibiotic therapy when a person's condition is stable improve treatment? How bronchiectasis is treated 29 Can having regular computed tomography scans to look for changes and increased risk of an exacerbation improve monitoring? How each person's bronchiectasis is monitored CF: cystic fibrosis.
Disclosures
ERJ Podcast
Duration: 09:07 min
Presenter: Marc Humbert, Chief Editor, ERJ
Interviewee: James D. Chalmers, College of Medicine, University of Dundee, Dundee, UK
Articles discussed:
- Aliberti S, Masefield S, Polverino E, et al. Research priorities in bronchiectasis: a consensus statement from the EMBARC Clinical Research Collaboration. Eur Respir J 2016; 48: 632-647. Full Text
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Vol 48 Issue 3
Table of Contents
Research priorities in bronchiectasis: a consensus statement from the EMBARC Clinical Research Collaboration
