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Bronchiectasis

The Experts below are selected from a list of 33345 Experts worldwide ranked by ideXlab platform

Anthony De Soyza – 1st expert on this subject based on the ideXlab platform

  • british thoracic society guideline for Bronchiectasis in adults
    Thorax, 2019
    Co-Authors: Adam T Hill, Anthony De Soyza, Stuart J Elborn, James D Chalmers, Anita L Sullivan, Andres R Floto, Lizzie Grillo, Kevin Gruffyddjones, Alex Harvey

    Abstract:

    ### How should the diagnosis of Bronchiectasis be determined?

    #### Recommendations – Imaging

    #### Good practice points

    CT imaging protocol

    CT features of Bronchiectasis

    General

    ### In whom should the diagnosis of Bronchiectasis be suspected?

    #### Recommendations

  • Cough and Bronchiectasis
    Pulmonary Pharmacology & Therapeutics, 2017
    Co-Authors: Paul Mccallion, Anthony De Soyza

    Abstract:

    Abstract Bronchiectasis is a chronic lung disease with permanent airway dilatation, mucus retention and recurrent lower respiratory tract infections. Bronchiectasis is increasing in prevalence and has a significant morbidity and an excess mortality rate over age matched controls. It is increasingly identified during investigations into chronic cough and is evident high resolution CT scanning. There remain significant knowledge gaps in our understanding of the epidemiology, pathophysiology, prognosis and optimal treatments in Bronchiectasis. This article reviews current concepts in Bronchiectasis and focusses on the complex aspects of chronic cough in this setting. Cough is important in Bronchiectasis as it is one of the most common presenting symptoms, it affects a patients’ quality of life and in conjunction with cough hypersensitivity and airway hyper responsiveness may limit the successful uptake of treatment modalities such as inhaled antibiotics and/or inhaled mucoactive therapies. Effective coughing often assisted by physiotherapy is a cornerstone of bronchial toileting in Bronchiectasis. Some patients however have ongoing non-productive cough symptoms suggesting a cough sensitisation syndrome. Post nasal drip and gastro-oesophageal reflux may complicate Bronchiectasis and further lead to intractable cough syndromes. There may be multiple cough syndromes within an individual at interplay and careful assessment and multidisciplinary working is needed to optimize symptom control. This article also highlights the many unknowns in chronic cough in Bronchiectasis.

  • pulmonary exacerbation in adults with Bronchiectasis a consensus definition for clinical research
    European Respiratory Journal, 2017
    Co-Authors: Adam T Hill, Anthony De Soyza, Stefano Aliberti, C S Haworth, Alan F Barker, Francesco Blasi, Wim Boersma, James D Chalmers, Katerina Dimakou, Stuart J Elborn

    Abstract:

    There is a need for a clear definition of exacerbations used in clinical trials in patients with Bronchiectasis. An expert conference was convened to develop a consensus definition of an exacerbation for use in clinical research.

    A systematic review of exacerbation definitions used in clinical trials from January 2000 until December 2015 and involving adults with Bronchiectasis was conducted. A Delphi process followed by a round-table meeting involving Bronchiectasis experts was organised to reach a consensus definition. These experts came from Europe (representing the European Multicentre Bronchiectasis Research Collaboration), North America (representing the US Bronchiectasis Research Registry/COPD Foundation), Australasia and South Africa.

    The definition was unanimously approved by the working group as: a person with Bronchiectasis with a deterioration in three or more of the following key symptoms for at least 48 h: cough; sputum volume and/or consistency; sputum purulence; breathlessness and/or exercise tolerance; fatigue and/or malaise; haemoptysis AND a clinician determines that a change in Bronchiectasis treatment is required.

    The working group proposes the use of this consensus-based definition for Bronchiectasis exacerbation in future clinical research involving adults with Bronchiectasis.

    An expert conference has developed a consensus definition of a Bronchiectasis exacerbation for clinical research

Anne B Chang – 2nd expert on this subject based on the ideXlab platform

  • Australian adults with Bronchiectasis: The first report from the Australian Bronchiectasis Registry
    Respiratory Medicine, 2019
    Co-Authors: Simone Visser, Paul Thomas King, Anne B Chang, Lucy D. Burr, Chien Li Holmes-liew, Peter G. Middleton, Graeme P. Maguire, Daniel J. Smith

    Abstract:

    Abstract Background /objective: There are no large, multi-centre studies of Australians with Bronchiectasis. The Australian Bronchiectasis Registry (ABR) was established in 2015 to create a longitudinal research platform. We aimed to describe the baseline characteristics of adult ABR participants and assess the impact of disease severity and exacerbation phenotype on quality of life (QoL). Methods The ABR is a centralised database of patients with radiologically confirmed Bronchiectasis unrelated to cystic fibrosis. We analysed the baseline data of adult patients (≥18 years). Results From March 2016–August 2018, 799 adults were enrolled from 14 Australian sites. Baseline data were available for 589 adults predominantly from six tertiary centres (420 female, median age 71 years (interquartile range 64–77), 14% with chronic Pseudomonas aeruginosa infection). Most patients had moderate or severe disease based on the Bronchiectasis Severity Index (BSI) (84%) and FACED (59%) composite scores. Using Global Lung function Initiative-2012 reference equations, the majority of patients (48%) had normal spirometry; only 34% had airflow obstruction (FEV1/FVC  Conclusions The largest cohort of Australian adults with Bronchiectasis has been described. Using contemporary criteria, most patients with Bronchiectasis did not have airflow obstruction. The frequent exacerbation trait connotes poorer QoL and greater health-care utilisation.

  • Bronchiectasis.
    Nature reviews. Disease primers, 2018
    Co-Authors: James D Chalmers, Anne B Chang, Sanjay H Chotirmall, Raja Dhar, Pamela J. Mcshane

    Abstract:

    Bronchiectasis refers to abnormal dilatation of the bronchi. Airway dilatation can lead to failure of mucus clearance and increased risk of infection. Pathophysiological mechanisms of Bronchiectasis include persistent bacterial infections, dysregulated immune responses, impaired mucociliary clearance and airway obstruction. These mechanisms can interact and self-perpetuate, leading over time to impaired lung function. Patients commonly present with productive cough and recurrent chest infections, and the diagnosis of Bronchiectasis is based on clinical symptoms and radiological findings. Bronchiectasis can be the result of several different underlying disorders, and identifying the aetiology is crucial to guide management. Treatment is directed at reducing the frequency of exacerbations, improving quality of life and preventing disease progression. Although no therapy is licensed for Bronchiectasis by regulatory agencies, evidence supports the effectiveness of airway clearance techniques, antibiotics and mucolytic agents, such as inhaled isotonic or hypertonic saline, in some patients. Bronchiectasis is a disabling disease with an increasing prevalence and can affect individuals of any age. A major challenge is the application of emerging phenotyping and endotyping techniques to identify the patient populations who would most benefit from a specific treatment, with the goal of better targeting existing and emerging treatments and achieving better outcomes.

  • Bronchiectasis in children diagnosis and treatment
    The Lancet, 2018
    Co-Authors: Anne B Chang, Keith Grimwood, Andrew Bush

    Abstract:

    Summary Bronchiectasis is conventionally defined as irreversible dilatation of the bronchial tree. Bronchiectasis unrelated to cystic fibrosis is an increasingly appreciated cause of chronic respiratory-related morbidity worldwide. Few randomised controlled trials provide high-level evidence for management strategies to treat the children affected by Bronchiectasis. However, both decades-old and more recent studies using technological advances support the notion that prompt diagnosis and optimal management of paediatric Bronchiectasis is particularly important in early childhood. Although considered to be of a non-reversible nature, mild Bronchiectasis determined by radiography might be reversible at any age if treated early, and the lung function decline associated with disease progression could then be halted. Although some management strategies are extrapolated from cystic fibrosis or adult-based studies, or both, non-cystic fibrosis paediatric-specific data to help diagnose and manage these children still need to be generated. We present current knowledge and an updated definition of Bronchiectasis, and review controversies relating to the management of children with Bronchiectasis, including applying the concept of so-called treatable traits.

James D Chalmers – 3rd expert on this subject based on the ideXlab platform

  • Is Bronchiectasis really a disease
    European Respiratory Review, 2020
    Co-Authors: Michal Shteinberg, Patrick A. Flume, James D Chalmers

    Abstract:

    The definition of a disease requires that distinguishing signs and symptoms are present that are common, and that the constellation of signs and symptoms differentiate the condition from other causes. In Bronchiectasis, anatomical changes, airways inflammation and airway infection are the distinguishing features that are common to this disease. However, Bronchiectasis is a heterogenous disease: signs and symptoms are shared with other airway diseases, there are multiple aetiologies and certain phenotypes of Bronchiectasis have distinct clinical and laboratory features that are not common to all people with Bronchiectasis. Furthermore, response to therapeutic interventions in clinical trials is not uniform. The concept of Bronchiectasis as a treatable trait has been suggested, but this may be too restrictive in view of the heterogeneity of Bronchiectasis. It is our opinion that Bronchiectasis should be defined as a disease in its own right, but one that shares several pathophysiological features and “treatable traits” with other airway diseases. These traits define the large heterogeneity in the pathogenesis and clinical features and suggest a more targeted approach to therapy.

  • british thoracic society guideline for Bronchiectasis in adults
    Thorax, 2019
    Co-Authors: Adam T Hill, Anthony De Soyza, Stuart J Elborn, James D Chalmers, Anita L Sullivan, Andres R Floto, Lizzie Grillo, Kevin Gruffyddjones, Alex Harvey

    Abstract:

    ### How should the diagnosis of Bronchiectasis be determined?

    #### Recommendations – Imaging

    #### Good practice points

    CT imaging protocol

    CT features of Bronchiectasis

    General

    ### In whom should the diagnosis of Bronchiectasis be suspected?

    #### Recommendations

  • Bronchiectasis.
    Nature reviews. Disease primers, 2018
    Co-Authors: James D Chalmers, Anne B Chang, Sanjay H Chotirmall, Raja Dhar, Pamela J. Mcshane

    Abstract:

    Bronchiectasis refers to abnormal dilatation of the bronchi. Airway dilatation can lead to failure of mucus clearance and increased risk of infection. Pathophysiological mechanisms of Bronchiectasis include persistent bacterial infections, dysregulated immune responses, impaired mucociliary clearance and airway obstruction. These mechanisms can interact and self-perpetuate, leading over time to impaired lung function. Patients commonly present with productive cough and recurrent chest infections, and the diagnosis of Bronchiectasis is based on clinical symptoms and radiological findings. Bronchiectasis can be the result of several different underlying disorders, and identifying the aetiology is crucial to guide management. Treatment is directed at reducing the frequency of exacerbations, improving quality of life and preventing disease progression. Although no therapy is licensed for Bronchiectasis by regulatory agencies, evidence supports the effectiveness of airway clearance techniques, antibiotics and mucolytic agents, such as inhaled isotonic or hypertonic saline, in some patients. Bronchiectasis is a disabling disease with an increasing prevalence and can affect individuals of any age. A major challenge is the application of emerging phenotyping and endotyping techniques to identify the patient populations who would most benefit from a specific treatment, with the goal of better targeting existing and emerging treatments and achieving better outcomes.