Treatment & management

How is bronchiectasis managed?

Managing bronchiectasis effectively can require a broad range of healthcare providers from primary healthcare, hospital care through to palliative care for those with advanced disease. As such, it is ideally managed in the community with primary healthcare providers acting as coordinators of care [1]. However, despite the important role it plays, there are currently limited detailed data on primary health care consultations in Australia.

Clinical practice guidelines in Australia and New Zealand recommend early diagnosis and coordination of multidisciplinary care needs. Chest high-resolution computed tomography scan (C-HRCT) is required to confirm the diagnosis and to assess severity and extent of the disease; with specific criteria and protocol required for children [2]. Although, the condition is complex because of the variety of underlying causes. Clinical decisions around the management of the condition are made based on individual presentations. Treatment may include physiotherapy, use of medicines (particularly to control infections), regular influenza vaccinations and, where appropriate, surgery [3].

Hospital statistics for bronchiectasis

Some people with bronchiectasis require treatment in hospital, particularly for the management of severe disease exacerbations. Separation is the term used to refer to the episode of admitted patient care, which can be a total hospital stay (from admission to discharge, transfer or death) or a portion of a hospital stay beginning or ending in a change of type of care (for example, from acute to rehabilitation care) [4].

The National Hospital Morbidity Database (NHMD) collects information about care provided to admitted patients in Australian Hospitals. The principal diagnosis is the diagnosis established after study to be chiefly responsible for occasioning the patient’s episode of admitted patient care. An additional diagnosis is a condition or a complaint that either coexists with the principal diagnosis or arises during the episode of care. An additional diagnosis is reported if the condition affects patient management. An admitted patient is a patient who undergoes a hospital’s formal admission process to receive treatment and / or care [4].

The AIHW NHMD 2015–16 showed:

  • bronchiectasis was the principal diagnosis for 7,082 hospitalisations and an additional diagnosis for a further 10,222 hospitalisations accounting for a small proportion (0.2%) of all hospitalisations in that year
  • the hospitalisation rate for females with a principal diagnosis of bronchiectasis (34 per 100,000 population) was almost twice that for males (18  per 100,000 population)
  • the average length of stay in hospital when bronchiectasis was recorded as a principal diagnosis was 6.7 days compared to 3 days for all hospitalisations.

The hospitalisation rate for bronchiectasis as a principal diagnosis increased steadily from 2006–07 to 2015–16 (from 19 to 26 per 100,000 population respectively). The rate increased for both females (25 per 100,000 population to 34 per 100,000 population) and males (12 per 100,000 population to 18 per 100,000 population) (Figure 1). It is not possible to determine from the source data to what extent this increase is due to an increase in the prevalence of the condition or in other factors affecting hospitalisation rates.

Figure 1: Rate of hospitalisations where bronchiectasis was the principal diagnosis, 2006–07 to 2015–16

Figure 1 shows that the rate of hospitalisations where bronchiectasis was the principal diagnosis has increased steadily since 2006–07 to 2015–16.

Notes:

  1. Rates are age-standardised to the Australian population as at 30 June 2001.
  2. Acute admitted patient care includes separation for which the care type was reported as Acute, Newborn (with qualified days) or was not reported.

Source: AIHW National Hospital Morbidity Database (Data table 1).

Bronchiectasis as an additional diagnosis

In 2015–16, for the 10,222 hospitalisations where bronchiectasis was an additional diagnosis, chronic obstructive pulmonary disease (COPD) (18%), cystic fibrosis (14%) and pneumonia (14%) were the three most common principal diagnoses.
In the younger age groups (0–4 to 45–49), bronchiectasis as an additional diagnosis was more often related to principal cystic fibrosis, while in older age groups (55 and over), it was more often associated with COPD and, pneumonia (Figure 2).

Figure 2: Rate of hospitalisations where bronchiectasis was an additional diagnosis, 2015–16

Figure 2 shows that the number of hospitalisations where bronchiectasis is an additional diagnosis is highest among those aged 50 years and over that have a principal diagnosis of COPD and Pneumonia.

Note:

  1. Acute admitted patient care includes separation for which the care type was reported as Acute, Newborn (with qualified days) or was not reported.

Source: AIHW National Hospital Morbidity Database (Data table 2).

References

  1. McGuire G 2012. Bronchiectasis. A guide for primary care. Australian Family Physician 41: 842–50.
  2. The Thoracic Society of Australia and New Zealand 2014. Chronic Suppurative Lung Disease and Bronchiectasis in children and adults in Australia and New Zealand. Clinical Practice Guideline. Sydney: Thoracic Society of Australia and New Zealand.
  3. Chang A, Bell S, Byrnes A, Grimwood K Holmes, P, King P et al. 2010. Chronic suppuratives lung disease and bronchiectasis in children and adults in Australia and New Zealand. Position statement from the Thoracic Society of Australia and New Zealand and the Australian Lung Foundation. Medical Journal of Australia 193:356–65.
  4. Australian Institute of Health and Welfare 2017. Admitted patient care 2015–16: Australian hospital statistics. Health services series no.75. Cat. no. HSE 185. Canberra: AIHW.