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Anthony De Soyza - One of the best experts on this subject based on the ideXlab platform.
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british thoracic society guideline for Bronchiectasis in adults
Thorax, 2019Co-Authors: Adam T Hill, Anthony De Soyza, James D Chalmers, Stuart J Elborn, Anita L Sullivan, Andres R Floto, Lizzie Grillo, Kevin Gruffyddjones, Alex HarveyAbstract:### 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
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Cough and Bronchiectasis
Pulmonary Pharmacology & Therapeutics, 2017Co-Authors: Paul Mccallion, Anthony De SoyzaAbstract: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.
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pulmonary exacerbation in adults with Bronchiectasis a consensus definition for clinical research
European Respiratory Journal, 2017Co-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 ElbornAbstract: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
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research priorities in Bronchiectasis a consensus statement from the embarc clinical research collaboration
European Respiratory Journal, 2016Co-Authors: Stefano Aliberti, Anthony De Soyza, Montserrat Vendrell, Felix C Ringshausen, Eva Polverino, Michael R Loebinger, Sarah Masefield, Rosario Menendez, Pippa PowellAbstract:Bronchiectasis is a disease of renewed interest in light of an increase in prevalence and increasing burden on international healthcare systems. There are no licensed therapies, and large gaps in knowledge in terms of epidemiology, pathophysiology and therapy. The European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) is a European Respiratory Society (ERS) Clinical Research Collaboration, funded by ERS to promote high-quality research in Bronchiectasis. The objective of this consensus statement was to define research priorities in Bronchiectasis. From 2014 to 2015, EMBARC used a modified Delphi process among European Bronchiectasis experts to reach a consensus on 55 key research priorities in this field. During the same period, the European Lung Foundation collected 711 questionnaires from adult patients with Bronchiectasis and their carers from 22 European countries reporting important research priorities from their perspective. This consensus statement reports recommendations for Bronchiectasis research after integrating both physicians and patients priorities, as well as those uniquely identified by the two groups. Priorities identified in this consensus statement provide the clearest possible roadmap towards improving our understanding of the disease and the quality of care for patients with Bronchiectasis.
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etiology of non cystic fibrosis Bronchiectasis in adults and its correlation to disease severity
Annals of the American Thoracic Society, 2015Co-Authors: Sara Lonni, Anthony De Soyza, James D Chalmers, Katerina Dimakou, Eva Polverino, Melissa J Mcdonnell, Pieter Goeminne, Charlotte Van De KerkhoveAbstract:Rationale: Testing for underlying etiology is a key part of Bronchiectasis management, but it is unclear whether the same extent of testing is required across the spectrum of disease severity.Objectives: The aim of the present study was to identify the etiology of Bronchiectasis across European cohorts and according to different levels of disease severity.Methods: We conducted an analysis of seven databases of adult outpatients with Bronchiectasis prospectively enrolled at the Bronchiectasis clinics of university teaching hospitals in Monza, Italy; Dundee and Newcastle, United Kingdom; Leuven, Belgium; Barcelona, Spain; Athens, Greece; and Galway, Ireland. All the patients at every site underwent the same comprehensive diagnostic workup as suggested by the British Thoracic Society.Measurements and Main Results: Among the 1,258 patients enrolled, an etiology of Bronchiectasis was determined in 60%, including postinfective (20%), chronic obstructive pulmonary disease related (15%), connective tissue disease...
Anne B Chang - One of the best experts on this subject based on the ideXlab platform.
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Australian adults with Bronchiectasis: The first report from the Australian Bronchiectasis Registry
Respiratory Medicine, 2019Co-Authors: Simone Visser, Paul Thomas King, Anne B Chang, Lucy D. Burr, Chien Li Holmes-liew, Peter G. Middleton, Graeme P. Maguire, Daniel J. SmithAbstract: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.
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Bronchiectasis.
Nature reviews. Disease primers, 2018Co-Authors: James D Chalmers, Anne B Chang, Sanjay H Chotirmall, Raja Dhar, Pamela J. McshaneAbstract: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.
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Bronchiectasis in children diagnosis and treatment
The Lancet, 2018Co-Authors: Anne B Chang, Andrew Bush, Keith GrimwoodAbstract: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.
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An update on pediatric Bronchiectasis
Expert Review of Respiratory Medicine, 2017Co-Authors: Danielle F. Wurzel, Anne B ChangAbstract:ABSTRACTIntroduction: The prevalence and awareness of Bronchiectasis not related to cystic fibrosis (CF) is increasing and it is now recognized as a major cause of respiratory morbidity, mortality and healthcare utilization worldwide. The need to elucidate the early origins of Bronchiectasis is increasingly appreciated and has been identified as an important research priority. Current treatments for pediatric Bronchiectasis are limited to antimicrobials, airway clearance techniques and vaccination. Several new drugs targeting airway inflammation are currently in development.Areas covered: Current management of pediatric Bronchiectasis, including discussion on therapeutics, non-pharmacological interventions and preventative and surveillance strategies are covered in this review. We describe selected adult and pediatric data on Bronchiectasis treatments and briefly discuss emerging therapeutics in the field.Expert commentary:Despite the burden of disease, the number of studies evaluating potential treatment...
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protracted bacterial bronchitis in children natural history and risk factors for Bronchiectasis
Chest, 2016Co-Authors: Danielle Wurzel, Julie M Marchant, Stephanie T Yerkovich, John W Upham, Helen Petsky, Heidi C Smithvaughan, B Masters, Helen M Buntain, Anne B ChangAbstract:Background Protracted bacterial bronchitis (PBB) and Bronchiectasis are distinct diagnostic entities that share common clinical and laboratory features. It is postulated, but remains unproved, that PBB precedes a diagnosis of Bronchiectasis in a subgroup of children. In a cohort of children with PBB, our objectives were to (1) determine the medium-term risk of Bronchiectasis and (2) identify risk factors for Bronchiectasis and recurrent episodes of PBB. Methods One hundred sixty-one children with PBB and 25 control subjects were prospectively recruited to this cohort study. A subset of 106 children was followed for 2 years. Flexible bronchoscopy, BAL, and basic immune function tests were performed. Chest CT was undertaken if clinical features were suggestive of Bronchiectasis. Results Of 161 children with PBB (66% boys), 13 were diagnosed with Bronchiectasis over the study period (8.1%). Almost one-half with PBB (43.5%) had recurrent episodes (> 3/y). Major risk factors for Bronchiectasis included lower airway infection with Haemophilus influenzae (recovered in BAL fluid) ( P = .013) and recurrent episodes of PBB ( P = .003). H influenzae infection conferred a more than seven times higher risk of Bronchiectasis (hazard ratio, 7.55; 95% CI, 1.66-34.28; P = .009) compared with no H influenzae infection. The majority of isolates (82%) were nontypeable H influenzae . No risk factors for recurrent PBB were identified. Conclusions PBB is associated with a future diagnosis of Bronchiectasis in a subgroup of children. Lower airway infection with H influenzae and recurrent PBB are significant predictors. Clinicians should be cognizant of the relationship between PBB and Bronchiectasis, and appropriate follow-up measures should be taken in those with risk factors.
James D Chalmers - One of the best experts on this subject based on the ideXlab platform.
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Is Bronchiectasis really a disease
European Respiratory Review, 2020Co-Authors: Michal Shteinberg, Patrick A. Flume, James D ChalmersAbstract: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.
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british thoracic society guideline for Bronchiectasis in adults
Thorax, 2019Co-Authors: Adam T Hill, Anthony De Soyza, James D Chalmers, Stuart J Elborn, Anita L Sullivan, Andres R Floto, Lizzie Grillo, Kevin Gruffyddjones, Alex HarveyAbstract:### 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
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Bronchiectasis.
Nature reviews. Disease primers, 2018Co-Authors: James D Chalmers, Anne B Chang, Sanjay H Chotirmall, Raja Dhar, Pamela J. McshaneAbstract: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.
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advances in Bronchiectasis endotyping genetics microbiome and disease heterogeneity
The Lancet, 2018Co-Authors: Patrick A. Flume, James D Chalmers, Kenneth N OlivierAbstract:Summary Bronchiectasis is characterised by pathological dilation of the airways. More specifically, the radiographic demonstration of airway enlargement is the common feature of a heterogeneous set of conditions and clinical presentations. No approved therapies exist for the condition other than for Bronchiectasis caused by cystic fibrosis. The heterogeneity of Bronchiectasis is a major challenge in clinical practice and the main reason for difficulty in achieving endpoints in clinical trials. Recent observations of the past 2 years have improved the understanding of physicians regarding Bronchiectasis, and have indicated that it might be more effective to classify patients in a different way. Patients could be categorised according to a heterogeneous group of endotypes (defined by a distinct functional or pathobiological mechanism) or by clinical phenotypes (defined by relevant and common features of the disease). In doing so, more specific therapies needed to effectively treat patients might finally be developed. Here, we describe some of the recent advances in endotyping, genetics, and disease heterogeneity of Bronchiectasis including observations related to the microbiome.
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Bronchiectasis new therapies and new perspectives
The Lancet Respiratory Medicine, 2018Co-Authors: James D Chalmers, Sanjay H ChotirmallAbstract:Summary European Respiratory Society guidelines for the management of adult Bronchiectasis highlight the paucity of treatment options available for patients with this disorder. No treatments have been licensed by regulatory agencies worldwide, and most therapies used in clinical practice are based on very little evidence. Development of new treatments is needed urgently. We did a systematic review of scientific literature and clinical trial registries to identify agents in early-to-late clinical development for Bronchiectasis in adults. In this Review, we discuss the mechanisms and potential roles of emerging therapies, including drugs that target airway and systemic inflammation, mucociliary clearance, and epithelial dysfunction. To ensure these treatments achieve success in randomised clinical trials—and therefore reach patients—we propose a reassessment of the current approach to Bronchiectasis. Although understanding of the pathophysiology of Bronchiectasis is at an early stage, we argue that Bronchiectasis is a heterogeneous disease with many different biological mechanisms that drive disease progression (endotypes), and therefore the so-called treatable traits approach used in asthma and chronic obstructive pulmonary disease could be applied to Bronchiectasis, with future trials targeted at the specific disease subgroups most likely to benefit.
Stefano Aliberti - One of the best experts on this subject based on the ideXlab platform.
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european respiratory society guidelines for the management of adult Bronchiectasis
European Respiratory Journal, 2017Co-Authors: Eva Polverino, Stefano Aliberti, Michael R Loebinger, Melissa J Mcdonnell, Pieter Goeminne, Sara E Marshall, Marlene Murris, Rafael Canton, Antoni TorresAbstract:Bronchiectasis in adults is a chronic disorder associated with poor quality of life and frequent exacerbations in many patients. There have been no previous international guidelines. The European Respiratory Society guidelines for the management of adult Bronchiectasis describe the appropriate investigation and treatment strategies determined by a systematic review of the literature. A multidisciplinary group representing respiratory medicine, microbiology, physiotherapy, thoracic surgery, primary care, methodology and patients considered the most relevant clinical questions (for both clinicians and patients) related to management of Bronchiectasis. Nine key clinical questions were generated and a systematic review was conducted to identify published systematic reviews, randomised clinical trials and observational studies that answered these questions. We used the GRADE approach to define the quality of the evidence and the level of recommendations. The resulting guideline addresses the investigation of underlying causes of Bronchiectasis, treatment of exacerbations, pathogen eradication, long term antibiotic treatment, anti-inflammatories, mucoactive drugs, bronchodilators, surgical treatment and respiratory physiotherapy. These recommendations can be used to benchmark quality of care for people with Bronchiectasis across Europe and to improve outcomes.
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pulmonary exacerbation in adults with Bronchiectasis a consensus definition for clinical research
European Respiratory Journal, 2017Co-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 ElbornAbstract: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
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comorbidities and the risk of mortality in patients with Bronchiectasis an international multicentre cohort study
The Lancet Respiratory Medicine, 2016Co-Authors: Stefano Aliberti, Melissa J Mcdonnell, Pieter Goeminne, Marcos I Restrepo, Simon Finch, Alberto Pesci, Lieven Dupont, Thomas C FardonAbstract:Summary Background Patients with Bronchiectasis often have concurrent comorbidities, but the nature, prevalence, and impact of these comorbidities on disease severity and outcome are poorly understood. We aimed to investigate comorbidities in patients with Bronchiectasis and establish their prognostic value on disease severity and mortality rate. Methods An international multicentre cohort analysis of outpatients with Bronchiectasis from four European centres followed up for 5 years was done for score derivation. Eligible patients were those with Bronchiectasis confirmed by high-resolution CT and a compatible clinical history. Comorbidity diagnoses were based on standardised definitions and were obtained from full review of paper and electronic medical records, prescriptions, and investigator definitions. Weibull parametric survival analysis was used to model the prediction of the 5 year mortality rate to construct the Bronchiectasis Aetiology Comorbidity Index (BACI). We tested the BACI as a predictor of outcomes and explored whether the BACI added further prognostic information when used alongside the Bronchiectasis Severity Index (BSI). The BACI was validated in two independent international cohorts from the UK and Serbia. Findings Between June 1, 2006, and Nov 22, 2013, 1340 patients with Bronchiectasis were screened and 986 patients were analysed. Patients had a median of four comorbidities (IQR 2–6; range 0–20). 13 comorbidities independently predicting mortality rate were integrated into the BACI. The overall hazard ratio for death conferred by a one-point increase in the BACI was 1·18 (95% CI 1·14–1·23; p vs BACI; p=0·008 for combined vs BSI). Interpretation Multimorbidity is frequent in Bronchiectasis and can negatively affect survival. The BACI complements the BSI in the assessment and prediction of mortality and disease outcomes in patients with Bronchiectasis. Funding European Bronchiectasis Network (EMBARC).
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Bronchiectasis and Aspergillus: How are they linked?
Medical Mycology, 2016Co-Authors: De Soyza A, Stefano AlibertiAbstract:Bronchiectasis is a chronic airway infection syndrome, distinct from cystic fibrosis that is rising in prevalence and is associated with significant morbidity and mortality. It can be caused by many etiologies including post-infectious effects or be seen in common lung diseases such as chronic obstructive pulmonary disease (COPD) or severe asthma. Bronchiectasis is associated with many Aspergillus-associated syndromes: allergic bronchopulmonary aspergillosis (ABPA) may complicate asthma, thus leading to Bronchiectasis as part of the diagnostic criteria of ABPA or can complicate preexisting Bronchiectasis due to another etiology. Aspergilloma can develop in areas of lung damage seen in patients with Bronchiectasis, whereas fungal bronchitis may lead to later Bronchiectasis. Invasive aspergillosis, perhaps more commonly viewed as a consequence of significant immunosuppression, is also seen in the absence of immunosuppression in those with underlying lung diseases including Bronchiectasis. The pathogenesis and treatments of these diverse Aspergillus-associated diseases in Bronchiectasis are discussed.
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research priorities in Bronchiectasis a consensus statement from the embarc clinical research collaboration
European Respiratory Journal, 2016Co-Authors: Stefano Aliberti, Anthony De Soyza, Montserrat Vendrell, Felix C Ringshausen, Eva Polverino, Michael R Loebinger, Sarah Masefield, Rosario Menendez, Pippa PowellAbstract:Bronchiectasis is a disease of renewed interest in light of an increase in prevalence and increasing burden on international healthcare systems. There are no licensed therapies, and large gaps in knowledge in terms of epidemiology, pathophysiology and therapy. The European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) is a European Respiratory Society (ERS) Clinical Research Collaboration, funded by ERS to promote high-quality research in Bronchiectasis. The objective of this consensus statement was to define research priorities in Bronchiectasis. From 2014 to 2015, EMBARC used a modified Delphi process among European Bronchiectasis experts to reach a consensus on 55 key research priorities in this field. During the same period, the European Lung Foundation collected 711 questionnaires from adult patients with Bronchiectasis and their carers from 22 European countries reporting important research priorities from their perspective. This consensus statement reports recommendations for Bronchiectasis research after integrating both physicians and patients priorities, as well as those uniquely identified by the two groups. Priorities identified in this consensus statement provide the clearest possible roadmap towards improving our understanding of the disease and the quality of care for patients with Bronchiectasis.
Adam T Hill - One of the best experts on this subject based on the ideXlab platform.
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british thoracic society guideline for Bronchiectasis in adults
Thorax, 2019Co-Authors: Adam T Hill, Anthony De Soyza, James D Chalmers, Stuart J Elborn, Anita L Sullivan, Andres R Floto, Lizzie Grillo, Kevin Gruffyddjones, Alex HarveyAbstract:### 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
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pulmonary exacerbation in adults with Bronchiectasis a consensus definition for clinical research
European Respiratory Journal, 2017Co-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 ElbornAbstract: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
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Bronchiectasis Severity Is an Independent Risk Factor for Vascular Disease in a Bronchiectasis Cohort
Chest, 2016Co-Authors: Ieuan Edward Shepherd Evans, Pallavi Bedi, Tom M. Quinn, Adam T HillAbstract:Background Interest in the association of vascular disease with COPD and pneumonia has increased, but there is a lack of research in this area with patients with Bronchiectasis. Methods A retrospective study of 400 patients attending a specialist Bronchiectasis clinic in NHS Lothian (Edinburgh, UK) between May 2013 and September 2014 was conducted. The study assessed the prevalence of vascular disease (ischemic heart disease, cerebrovascular disease, peripheral vascular disease, and atrial fibrillation). Using multivariable models, independent risk factors were identified for vascular disease that developed following the diagnosis of Bronchiectasis. Results The study included 400 patients. There was preexisting vascular disease (ie, before the diagnosis of Bronchiectasis) in 44 patients (11%), and vascular disease occurred after the diagnosis of Bronchiectasis after a mean of 9.4 years (95% CI, 6.0-12.8 years) in 45 patients (11%). Independent factors associated with all-cause vascular disease after the diagnosis of Bronchiectasis included male sex, hypertension, receiving long-term statin therapy, and having moderate-severity Bronchiectasis or worse. Conclusions In conclusion, Bronchiectasis severity is independently associated with the development of vascular disease after the diagnosis of Bronchiectasis. Future studies addressing the impact of primary and secondary prevention are warranted.
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british thoracic society guideline for non cf Bronchiectasis
Thorax, 2010Co-Authors: M C Pasteur, D Bilton, Adam T HillAbstract:The diagnosis, investigation and particularly management of Bronchiectasis has been largely empirical and the subject of relatively few controlled clinical trials. There are no clear guidelines, although an Australian position statement has been published concerning Bronchiectasis in children. The purposes of these guidelines were therefore threefold: (1) to identify relevant studies in non-cystic fibrosis (CF) Bronchiectasis; (2) to provide guidelines on management based on published studies where possible or a consensus view; and (3) to identify gaps in our knowledge and identify areas for future study.
