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Management of children and adolescents with bronchiectasis: summary of the ERS clinical practice guideline

Anne B. Chang, Keith Grimwood, Jeanette Boyd, Rebecca Fortescue, Zena Powell, Ahmad Kantar
Breathe 2021 17: 210105; DOI: 10.1183/20734735.0105-2021
Anne B. Chang
1Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia
2Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia
3Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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  • For correspondence: Anne.Chang@menzies.edu.au
Keith Grimwood
4Depts of Infectious Disease and Paediatrics, Gold Coast Health, Southport, Australia
5School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Southport, Australia
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Jeanette Boyd
6European Lung Foundation, Sheffield, UK
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Rebecca Fortescue
7Population Health Research Institute, St George's University of London, London, UK
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Zena Powell
8European Lung Foundation bronchiectasis paediatric patient advisory group, Sheffield, UK
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Ahmad Kantar
9Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy
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    Figure 1

    Contributing factors (host, socio-environmental and pathogen) to the development of chronic suppurative lung disease with key features of the pathobiology of bronchiectasis. If the pathways are not interrupted, the resulting airway remodelling eventually becomes irreversible, leading to severe/irreversible bronchiectasis.

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    Figure 2

    There are many different ACT. In children/adolescents, these are age-specific and best taught by physiotherapists experienced in managing children/adolescents with bronchiectasis. GAD: gravity-assisted drainage; PEP: positive expiratory pressure. Reproduced from the ERS CPG [4] with permission.

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    Figure 3

    Suggested management approach used by the panel when Pseudomonas aeruginosa is first or newly isolated in a child with bronchiectasis. The suggested approach depends upon: 1) the specimen type, and 2) whether the child is symptomatic. However, panel members acknowledged the approach to initiating eradication treatment is controversial. Some physicians may still feel it is appropriate to initiate eradication therapy based only on a single upper airway specimen, even when symptoms and evidence of benefit in such circumstances are absent. #: if no lower airway specimen available, no treatment if asymptomatic; treat with intravenous anti-pseudomonal antibiotics for 2 weeks if symptomatic. ¶: antibiotic choices are dependent upon patient factors (e.g. adherence, tolerance and preference), availability of antibiotics and P. aeruginosa susceptibility profile. +: although there is no trial evidence, many paediatricians use a combination of two intravenous antibiotics; the recommendation for administering two antibiotics when employing short (2-week) intravenous antibiotic courses is made to align with the studies included in the systematic review and the ERS adult guidelines [23]. Reproduced from the ERS CPG [4] with permission.

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Vol 17 Issue 3 Table of Contents
Breathe: 17 (3)
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Management of children and adolescents with bronchiectasis: summary of the ERS clinical practice guideline
Anne B. Chang, Keith Grimwood, Jeanette Boyd, Rebecca Fortescue, Zena Powell, Ahmad Kantar
Breathe Sep 2021, 17 (3) 210105; DOI: 10.1183/20734735.0105-2021

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Management of children and adolescents with bronchiectasis: summary of the ERS clinical practice guideline
Anne B. Chang, Keith Grimwood, Jeanette Boyd, Rebecca Fortescue, Zena Powell, Ahmad Kantar
Breathe Sep 2021, 17 (3) 210105; DOI: 10.1183/20734735.0105-2021
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  • Article
    • Abstract
    • Abstract
    • What is bronchiectasis?
    • Bronchiectasis is under-diagnosed and often not managed optimally
    • Diagnosis and evaluating causes
    • Management
    • Systematic care (NQ-3)
    • Monitoring (NQ-4)
    • Reversibility and prevention (NQ-2)
    • Conclusions and future perspectives
    • Acknowledgements
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF

Subjects

  • CF and non-CF bronchiectasis
  • Paediatric pulmonology
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