RESUMO
The new British Thoracic Society (BTS) Guideline for Bronchiectasis in Adults has been published. This article provides a summary of key highlights of the new BTS Guideline and covers who to investigate, what investigations should be carried out and a management strategy.
Assuntos
Bronquiectasia/diagnóstico , Bronquiectasia/terapia , Adulto , Humanos , Equipe de Assistência ao Paciente , Guias de Prática Clínica como Assunto , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: Bronchial thermoplasty (BT) is a novel treatment for severe asthma. Its mode of action and ideal target patient group remain poorly defined, though clinical trials provided some evidence on efficacy and safety. This study presents procedural and short-term safety evidence from routine UK clinical practice. METHODS: Patient characteristics and safety outcomes (procedural complications, 30-day readmission and accident and emergency (A&E) attendance, length of stay) were assessed using two independent data sources, the British Thoracic Society UK Difficult Asthma Registry (DAR) and Hospital Episodes Statistics (HES) database. A matched cohort (with records in both) was used to estimate safety outcome event rates and compare them with clinical trials. RESULTS: Between June 2011 and January 2015, 215 procedure records (83 patients; 68 treated in England) were available from DAR and 203 (85 patients) from HES. 152 procedures matched (59 patients; 6 centres), and of these, 11.2% reported a procedural complication, 11.8% resulted in emergency respiratory readmission, 0.7% in respiratory A&E attendance within 30 days (20.4% had at least one event) and 46.1% involved a post-procedure stay. Compared with published clinical trials which found lower hospitalisation rates, BT patients in routine clinical practice were, on average, older, had worse baseline lung function and asthma quality of life. CONCLUSIONS: A higher proportion of patients experienced adverse events compared with clinical trials. The greater severity of disease amongst patients treated in clinical practice may explain the observed rate of post-procedural stay and readmission. Study of long-term safety and efficacy requires continuing data collection.
Assuntos
Asma/cirurgia , Ablação por Cateter/métodos , Adulto , Fatores Etários , Idoso , Ablação por Cateter/efeitos adversos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Qualidade de Vida , Testes de Função Respiratória , Índice de Gravidade de Doença , Medicina Estatal , Reino UnidoRESUMO
The BTS pleural procedures audit collected data over a 2-month period in June and July 2011. In contrast with the 2010 audit, which focussed simply on chest drain insertions, data on all pleural aspirations and local anaesthetic thoracoscopy (LAT) was also collected. Ninety hospitals submitted data, covering a patient population of 33 million. Twenty-one per cent of centres ran a specialist pleural disease clinic, 71% had a nominated chest drain safety lead, and 20% had thoracic surgery on site. Additionally, one-third of centres had a physician-led LAT service.
Assuntos
Tubos Torácicos/normas , Auditoria Médica , Paracentese/normas , Segurança do Paciente , Toracoscopia/normas , Anestesia Local , Tubos Torácicos/efeitos adversos , Tubos Torácicos/estatística & dados numéricos , Hospitais/normas , Hospitais/estatística & dados numéricos , Humanos , Consentimento Livre e Esclarecido/estatística & dados numéricos , Paracentese/efeitos adversos , Paracentese/estatística & dados numéricos , Cavidade Pleural , Derrame Pleural/cirurgia , Pneumotórax/cirurgia , Sociedades Médicas , Toracoscopia/efeitos adversos , Toracoscopia/estatística & dados numéricos , Ultrassonografia de Intervenção/normas , Ultrassonografia de Intervenção/estatística & dados numéricos , Reino UnidoRESUMO
The British Thoracic Society (BTS) Guidelines for Bronchiectasis in adults were published in January 2019, and comprise recommendations for treatment from primary to tertiary care. Here, we outline the practical implications of these guidelines for primary care practitioners. A diagnosis of bronchiectasis should be considered when a patient presents with a recurrent or persistent (>8 weeks) productive cough. A definitive diagnosis is made by using thin-section chest computed tomography (CT). Once diagnosed, patients should be initially assessed by a specialist respiratory team and a shared management plan formulated with the patient, the specialist and primary care teams. The cornerstone of primary care management is physiotherapy to improve airway sputum clearance and maximise exercise capacity, with prompt treatment of acute exacerbations with antibiotics.