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
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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
