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Task Force report: European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis

Anne B. Chang, Rebecca Fortescue, Keith Grimwood, Efthymia Alexopoulou, Leanne Bell, Jeanette Boyd, Andrew Bush, James D. Chalmers, Adam T. Hill, Bulent Karadag, Fabio Midulla, Gabrielle B. McCallum, Zena Powell, Deborah Snijders, Woo-Jung Song, Thomy Tonia, Christine Wilson, Angela Zacharasiewicz, Ahmad Kantar
European Respiratory Journal 2021; DOI: 10.1183/13993003.02990-2020
Anne B. Chang
1Department of Respiratory and Sleep Medicine, Queensland Children's Hospital; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
2Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
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Rebecca Fortescue
3Population Health Research Institute, St George's University of London, London, United Kingdom
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Keith Grimwood
4Departments of Infectious Disease and Paediatrics, Gold Coast Health, Southport, Queensland, Australia
5School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Southport, Queensland, Australia
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Efthymia Alexopoulou
62nd Radiology Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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Leanne Bell
7European Lung Foundation bronchiectasis paediatric patient advisory group, Alnwick, United Kingdom
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Jeanette Boyd
8European Lung Foundation, Sheffield, United Kingdom
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Andrew Bush
9Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial School of Medicine, London, UK
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James D. Chalmers
10College of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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Adam T. Hill
11Dept of Respiratory Medicine, Royal Infirmary and University of Edinburgh, Edinburgh, UK
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Bulent Karadag
12Division of Pediatric Pulmonology, Marmara University Faculty of Medicine, Istanbul, Turkey
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Fabio Midulla
13Department of Maternal Science, Sapienza University of Rome, Rome, Italy
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Gabrielle B. McCallum
2Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
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Zena Powell
7European Lung Foundation bronchiectasis paediatric patient advisory group, Alnwick, United Kingdom
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Deborah Snijders
14Dipartimento Salute della Donna e del Bambino, Università degli Studi di Padova, Padova, Italy
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Woo-Jung Song
15Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Thomy Tonia
16Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Christine Wilson
17Department of Physiotherapy, Queensland Children's Hospital, Brisbane, Queensland, Australia
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Angela Zacharasiewicz
18Department of Pediatrics, and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Klinikum Ottakring Vienna, Wien, Austria
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Ahmad Kantar
19Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Ponte San Pietro-Bergamo, Bergamo, Italy
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Abstract

There is increasing awareness of bronchiectasis in children and adolescents, a chronic pulmonary disorder associated with poor quality-of-life for the child/adolescent and their parents, recurrent exacerbations and costs to the family and health systems. Optimal treatment improves clinical outcomes. Several national guidelines exist, but there are no international guidelines.

The European Respiratory Society (ERS) Task Force for the management of paediatric bronchiectasis sought to identify evidence-based management (investigation and treatment) strategies. It used the ERS standardised process that included a systematic review of the literature and application of the GRADE approach to define the quality of the evidence and level of recommendations.

A multidisciplinary team of specialists in paediatric and adult respiratory medicine, infectious disease, physiotherapy, primary care, nursing, radiology, immunology, methodology, patient advocacy and parents of children/adolescents with bronchiectasis considered the most relevant clinical questions (for both clinicians and patients) related to managing paediatric bronchiectasis. Fourteen key clinical questions (7 “Patient, Intervention, Comparison, Outcome” [PICO] and 7 narrative) were generated. The outcomes for each PICO were decided by voting by the panel and parent advisory group.

This guideline addresses the definition, diagnostic approach and antibiotic treatment of exacerbations, pathogen eradication, long-term antibiotic therapy, asthma-type therapies (inhaled corticosteroids, bronchodilators), mucoactive drugs, airway clearance, investigation of underlying causes of bronchiectasis, disease monitoring, factors to consider before surgical treatment and the reversibility and prevention of bronchiectasis in children/adolescents. Benchmarking quality of care for children/adolescents with bronchiectasis to improve clinical outcomes and evidence gaps for future research could be based on these recommendations.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: Dr. Kohli has nothing to disclose.

Conflict of interest: Dr. Chang reports grants from National Health and Medical Research Council, Australia (NHMRC); Other fees to the institution from work relating to being a IDMC Member of an unlicensed vaccine (GSK) and an advisory member of study design for unlicensed molecule for chronic cough (Merck) outside the submitted work.

Conflict of interest: Dr. Fortescue has nothing to disclose.

Conflict of interest: Dr. Grimwood reports grants from National Health and Medical Research Council, Australia (NHMRC), during the conduct of the study.

Conflict of interest: Dr E. Alexopoulou has nothing to disclose

Conflict of interest: Dr. Bell has nothing to disclose.

Conflict of interest: Jeanette Boyd has nothing to disclose.

Conflict of interest: Dr. Bush has nothing to disclose.

Conflict of interest: Dr. Chalmers reports grants and personal fees from AstraZeneca, grants and personal fees from Boehringer-Ingelheim, personal fees from Chiesi, grants and personal fees from Glaxosmithkline, grants from Gilead Sciences, personal fees from Novartis, grants and personal fees from Insmed, personal fees from Zambon, outside the submitted work.

Conflict of interest: Prof. Hill has nothing to disclose.

Conflict of interest: Dr. Karadag has nothing to disclose.

Conflict of interest: Dr. Midulla has nothing to disclose.

Conflict of interest: Dr. McCallum has nothing to disclose.

Conflict of interest: Z Powell has nothing to disclose.

Conflict of interest: Dr. snijders has nothing to disclose.

Conflict of interest: Dr. Song has nothing to disclose.

Conflict of interest: Ms Tonia reports acting an ERS Methodologist .

Conflict of interest: Dr. Wilson has nothing to disclose.

Conflict of interest: Angela Zacharasiewicz has nothing to disclose.

Conflict of interest: Dr. Kantar has nothing to disclose.

This is a PDF-only article. Please click on the PDF link above to read it.

  • Received August 1, 2020.
  • Accepted December 21, 2020.
  • ©The authors 2021. For reproduction rights and permissions contact permissions{at}ersnet.org
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Task Force report: European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis
Anne B. Chang, Rebecca Fortescue, Keith Grimwood, Efthymia Alexopoulou, Leanne Bell, Jeanette Boyd, Andrew Bush, James D. Chalmers, Adam T. Hill, Bulent Karadag, Fabio Midulla, Gabrielle B. McCallum, Zena Powell, Deborah Snijders, Woo-Jung Song, Thomy Tonia, Christine Wilson, Angela Zacharasiewicz, Ahmad Kantar
European Respiratory Journal Jan 2021, 2002990; DOI: 10.1183/13993003.02990-2020

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Task Force report: European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis
Anne B. Chang, Rebecca Fortescue, Keith Grimwood, Efthymia Alexopoulou, Leanne Bell, Jeanette Boyd, Andrew Bush, James D. Chalmers, Adam T. Hill, Bulent Karadag, Fabio Midulla, Gabrielle B. McCallum, Zena Powell, Deborah Snijders, Woo-Jung Song, Thomy Tonia, Christine Wilson, Angela Zacharasiewicz, Ahmad Kantar
European Respiratory Journal Jan 2021, 2002990; DOI: 10.1183/13993003.02990-2020
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