Treatment & management

The Department of Health’s National Strategic Action Plan for Lung Conditions (the Action Plan) provides a detailed, person-centred roadmap for treating and managing COPD, among several other lung conditions (Department of Health 2019). The Action Plan outlines a comprehensive, collaborative and evidence-based approach to reducing the individual and societal burden of lung conditions and improving lung health (Department of Health 2019). The Action Plan can be found on the Lung Foundation Australia website.

How is bronchiectasis managed?

Although there is currently no cure for bronchiectasis, early treatment is important to help improve quality of life, manage symptoms, and maintain normal lung function.

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 (McGuire 2012). 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. A 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 (Chang et al. 2010).The condition is complex to manage because of the variety of underlying causes and so 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 (Chang et al. 2010).

Hospital statistics for bronchiectasis

Some people with bronchiectasis require treatment in hospital, particularly for the management of severe disease exacerbations.

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 (AIHW 2019).

The AIHW National Hospital Morbidity Database 2017–18 showed:

  • Bronchiectasis was the principal diagnosis for 7,719 hospitalisations and an additional diagnosis for a further 10,803 hospitalisations, accounting for a small proportion (0.2%) of all hospitalisations in this period.
  • The hospitalisation rate for females with a principal diagnosis of bronchiectasis (33 per 100,000 population) was 1.7 times that for males (19 per 100,000 population).
  • The average length of stay in hospital when bronchiectasis was recorded as a principal diagnosis was 6.3 days compared to 2.7 days for all hospitalisations.

During the period 2007–08 to 2016–17, the hospitalisation rate for bronchiectasis as a principal diagnosis increased steadily (from 20 to 28 per 100,000 population respectively); this rate increased for both females (26 to 36 per 100,000 population) and males (13 to 19 per 100,000 population). However, during the period 2016–17 to 2017–18, the hospitalisation rate for bronchiectasis as a principal diagnosis decreased slightly (from 28 to 27 per 100,000 population); this rate decreased for females (36 to 33 per 100,000 population), and remained the same for males (19 per 100,000 population) (Figure 1).

Figure 1: Age-standardised rate of hospitalisations where bronchiectasis was the principal diagnosis, by sex, 2008–09 to 2017–18

The line chart shows the age-standardised hospitalisation rate for bronchiectasis as a principal diagnosis from 2008–09 to 2017–18. From 2007–08 to 2016–17, the hospitalisation rate for bronchiectasis as a principal diagnosis increased steadily (from 20 to 28 per 100,000 population respectively); this rate increased for both females (26 to 36 per 100,000 population) and males (13 to 19 per 100,000 population). However, from 2016–17 to 2017–18, the hospitalisation rate for bronchiectasis as a principal diagnosis decreased slightly (from 28 to 27 per 100,000 population); this rate decreased for females (36 to 33 per 100,000 population), and remained the same for males (19 per 100,000 population).

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Bronchiectasis as an additional diagnosis

In 2017–18, for the 10,803 hospitalisations where bronchiectasis was an additional diagnosis, chronic obstructive pulmonary disease (COPD) (17%), pneumonia (14%) and cystic fibrosis (12%) 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 cystic fibrosis, while in older age groups (55 and over), it was more often associated with COPD and pneumonia (Figure 2).

Figure 2: Number of hospitalisations where bronchiectasis was an additional diagnosis, by age group, 2017–18

The line chart shows the number of hospitalisations where bronchiectasis was an additional diagnosis along with principal diagnoses of COPD, pneumonia and cystic fibrosis in 2017–18. In the younger age groups (0–4 to 45–49), bronchiectasis as an additional diagnosis was more often related to cystic fibrosis, while in older age groups (55 and over), it was more often associated with COPD and pneumonia.

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