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McShane PJ. To Boldly Go into Molecular Endotypes of Bronchiectasis Exacerbations. Am J Respir Crit Care Med 2024; 210:13-15. [PMID: 38949502 PMCID: PMC11197070 DOI: 10.1164/rccm.202405-0957ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Affiliation(s)
- Pamela J McShane
- Division of Pulmonary and Critical Care University of Texas Health Science Center at Tyler Tyler, Texas
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2
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Chang AB, Yerkovich ST, Baines KJ, Burr L, Champion A, Chatfield MD, Eg KP, Goyal V, Marsh RL, McCallum GB, McElrea M, McPhail S, Morgan LC, Morris PS, Nathan AM, O'Farrell H, Sanchez MO, Parsons M, Schultz A, Torzillo PJ, West NP, Versteegh L, Marchant JM, Grimwood K. Erdosteine in children and adults with bronchiectasis (BETTER trial): study protocol for a multicentre, double-blind, randomised controlled trial. BMJ Open Respir Res 2024; 11:e002216. [PMID: 38719503 PMCID: PMC11086403 DOI: 10.1136/bmjresp-2023-002216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Bronchiectasis is a worldwide chronic lung disorder where exacerbations are common. It affects people of all ages, but especially Indigenous populations in high-income nations. Despite being a major contributor to chronic lung disease, there are no licensed therapies for bronchiectasis and there remain relatively few randomised controlled trials (RCTs) conducted in children and adults. Our RCT will address some of these unmet needs by evaluating whether the novel mucoactive agent, erdosteine, has a therapeutic role in children and adults with bronchiectasis.Our primary aim is to determine in children and adults aged 2-49 years with bronchiectasis whether regular erdosteine over a 12-month period reduces acute respiratory exacerbations compared with placebo. Our primary hypothesis is that people with bronchiectasis who regularly use erdosteine will have fewer exacerbations than those receiving placebo.Our secondary aims are to determine the effect of the trial medications on quality of life (QoL) and other clinical outcomes (exacerbation duration, time-to-next exacerbation, hospitalisations, lung function, adverse events). We will also assess the cost-effectiveness of the intervention. METHODS AND ANALYSIS We are undertaking an international multicentre, double-blind, placebo-RCT to evaluate whether 12 months of erdosteine is beneficial for children and adults with bronchiectasis. We will recruit 194 children and adults with bronchiectasis to a parallel, superiority RCT at eight sites across Australia, Malaysia and Philippines. Our primary endpoint is the rate of exacerbations over 12 months. Our main secondary outcomes are QoL, exacerbation duration, time-to-next exacerbation, hospitalisations and lung function. ETHICS AND DISSEMINATION The Human Research Ethics Committees (HREC) of Children's Health Queensland (for all Australian sites), University of Malaya Medical Centre (Malaysia) and St. Luke's Medical Centre (Philippines) approved the study. We will publish the results and share the outcomes with the academic and medical community, funding and relevant patient organisations. TRIAL REGISTRATION NUMBER ACTRN12621000315819.
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Affiliation(s)
- Anne B Chang
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Stephanie T Yerkovich
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Katherine J Baines
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Immune Health Research Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Lucy Burr
- Mater Health Services, South Brisbane, Queensland, Australia
| | - Anita Champion
- Department of Pharmacy, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | | | - Kah P Eg
- Department of Paediatrics, Universiti Malaya Faculty of Medicine, Kuala Lumpur, Malaysia
| | - Vikas Goyal
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Robyn L Marsh
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Gabrielle B McCallum
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Margaret McElrea
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Steven McPhail
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Brisbane, Queensland, Australia
- Metro South Health, Clinical Informatics Directorate, Woollongabba, Queensland, Australia
| | - Lucy C Morgan
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Peter S Morris
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Anne M Nathan
- Department of Paediatrics, Universiti Malaya Faculty of Medicine, Kuala Lumpur, Malaysia
| | - Hannah O'Farrell
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Marion O Sanchez
- Section of Pediatric Pulmonology, Institute of Pulmonary Medicine, St. Luke's Medical Center, Quezon City, Philippines
| | - Marianne Parsons
- Parent Advisory Group, Cough, Asthma and Airways Group, Queensland University of Technology Faculty of Health, Kelvin Grove, Queensland, Australia
| | - André Schultz
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- Wal-yan Respiratory Research Centre, Telethon Kids Institute & Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Paul J Torzillo
- Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Sydney Medical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Nicholas P West
- School of Medicine and Dentistry, Griffith University Griffith Health, Gold Coast, Queensland, Australia
| | - Lesley Versteegh
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Julie M Marchant
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Keith Grimwood
- School of Medicine and Dentistry, Griffith University Griffith Health, Gold Coast, Queensland, Australia
- Departments of Infectious Disease and Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia
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Chang AB, Boyd J, Bush A, Hill AT, Powell Z, Zacharasiewicz A, Alexopoulou E, Collaro AJ, Chalmers JD, Constant C, Douros K, Fortescue R, Griese M, Grigg J, Hector A, Karadag B, Mazulov O, Midulla F, Moeller A, Proesmans M, Wilson C, Yerkovich ST, Kantar A, Grimwood K. A core outcome set for bronchiectasis in children and adolescents for use in clinical research: an international consensus study. THE LANCET. RESPIRATORY MEDICINE 2024; 12:78-88. [PMID: 38070531 DOI: 10.1016/s2213-2600(23)00233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 01/06/2024]
Abstract
Improving the treatment of non-cystic fibrosis bronchiectasis in children and adolescents requires high-quality research with outcomes that meet study objectives and are meaningful for patients and their parents and caregivers. In the absence of systematic reviews or agreement on the health outcomes that should be measured in paediatric bronchiectasis, we established an international, multidisciplinary panel of experts to develop a core outcome set (COS) that incorporates patient and parent perspectives. We undertook a systematic review from which a list of 21 outcomes was constructed; these outcomes were used to inform the development of separate surveys for ranking by parents and patients and by health-care professionals. 562 participants (201 parents and patients from 17 countries, 361 health-care professionals from 58 countries) completed the surveys. Following two consensus meetings, agreement was reached on a ten-item COS with five outcomes that were deemed to be essential: quality of life, symptoms, exacerbation frequency, non-scheduled health-care visits, and hospitalisations. Use of this international consensus-based COS will ensure that studies have consistent, patient-focused outcomes, facilitating research worldwide and, in turn, the development of evidence-based guidelines for improved clinical care and outcomes. Further research is needed to develop validated, accessible measurement instruments for several of the outcomes in this COS.
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | | | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial School of Medicine, London, UK
| | - Adam T Hill
- Dept of Respiratory Medicine, Royal Infirmary and University of Edinburgh, Edinburgh, UK
| | | | - Angela Zacharasiewicz
- Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Klinik Ottakring, Vienna, Austria
| | - Efthymia Alexopoulou
- 2nd Radiology Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Andrew J Collaro
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - James D Chalmers
- College of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Carolina Constant
- Department of Pediatrics, Hospital de Santa Maria and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Konstantinos Douros
- Allergology and Pulmonology Unit, 3rd Paediatric Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Rebecca Fortescue
- Population Health Research Institute, St George's University of London, London, UK
| | - Matthias Griese
- Department of Pediatrics, Dr von Hauner Children's Hospital, University Hospital, Ludwig Maximilian University of Munich, German Center for Lung Research (DZL), Munich, Germany
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Andreas Hector
- Department of Pulmonology, Children's Hospital, Winterthur, Switzerland
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Oleksandr Mazulov
- Pulmonology Department, National Pirogov Medical University, Vinnytsya Children's Regional Hospital, Vinnytsya, Ukraine
| | - Fabio Midulla
- Department of Maternal Science, Sapienza University of Rome, Rome, Italy
| | - Alexander Moeller
- Department of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Marijke Proesmans
- Pediatric Pulmonology, Department of Pediatrics, University Hospital of Leuven, Leuven, Belgium
| | - Christine Wilson
- Department of Physiotherapy, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Ponte San Pietro-Bergamo, Bergamo, Italy
| | - Keith Grimwood
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Departments of Infectious Disease and Paediatrics, Gold Coast Health, Gold Coast, QLD, Australia; School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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Goyal V, Yerkovich ST, Grimwood K, Marchant JM, Byrnes CA, Masters IB, Chang AB. Phenotypic Features of Pediatric Bronchiectasis Exacerbations Associated With Symptom Resolution After 14 Days of Oral Antibiotic Treatment. Chest 2023; 164:1378-1386. [PMID: 37437879 DOI: 10.1016/j.chest.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/12/2023] [Accepted: 07/01/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Respiratory exacerbations in children and adolescents with bronchiectasis are treated with antibiotics. However, antibiotics can have variable interindividual effects when treating exacerbations. RESEARCH QUESTION Can phenotypic features associated with symptom resolution after a 14-day course of oral antibiotics for a nonsevere exacerbation of bronchiectasis be identified? STUDY DESIGN AND METHODS Combining data from two multicenter randomized controlled trials, we identified 217 children with bronchiectasis assigned to at least 14 days of oral antibiotics to treat nonsevere (nonhospitalized) exacerbations. Univariable and then multivariable logistic regression were used to identify factors associated with symptom resolution within 14 days of commencing antibiotics. Identified associations were re-evaluated by mediation analysis. RESULTS Of the 217 study participants (52% male patients), 41% were Indigenous (Australian First Nations, New Zealand Māori, or Pacific Islander). The median age was 6.6 years (interquartile range, 4.0-10.1 years). By day 14, symptoms had resolved in 130 children (responders), but persisted in the remaining 87 children (nonresponders). Multivariable analysis found those who were Indigenous (adjusted OR [AOR], 3.59; 95% CI, 1.35-9.54) or showed new abnormal auscultatory findings (AOR, 3.85; 95% CI, 1.56-9.52) were more likely to be responders, whereas those with multiple bronchiectatic lobes at diagnosis (AOR, 0.66; 95% CI, 0.46-0.95) or higher cough scores when starting exacerbation treatment (AOR, 0.55; 95% CI, 0.34-0.90) were more likely to be nonresponders. Detecting a respiratory virus at the beginning of an exacerbation was not associated with antibiotic failure at 14 days. INTERPRETATION Children with Indigenous ethnicity, milder bronchiectasis, mild exacerbations (low reported cough scores), or new abnormal auscultatory signs are more likely to respond to appropriate oral antibiotics than those without these features. These patient and exacerbation phenotypes may assist clinical management and development of biomarkers to identify those whose symptoms are more likely to resolve after 14 days of oral antibiotics. TRIAL REGISTRY Australian New Zealand Clinical Trials Registry; Nos.: ACTRN12612000011886 and ACTRN12612000010897; URL: https://www.anzctr.org.au.
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Affiliation(s)
- Vikas Goyal
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; Department of Paediatrics, Gold Coast Health, Griffith University, Gold Coast, QLD, Australia.
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis, Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Keith Grimwood
- Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Griffith University Gold Coast, QLD, Australia; School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Catherine A Byrnes
- Department of Paediatrics, University of Auckland, Starship Children's Health & Kidz First Hospital, Auckland, New Zealand; Paediatric Respiratory Medicine, Starship Children's Health & Kidz First Hospital, Auckland, New Zealand
| | - Ian Brent Masters
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis, Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
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Roberts JM, Goyal V, Kularatna S, Chang AB, Kapur N, Chalmers JD, Goeminne PC, Hernandez F, Marchant JM, McPhail SM. The Economic Burden of Bronchiectasis: A Systematic Review. Chest 2023; 164:1396-1421. [PMID: 37423293 DOI: 10.1016/j.chest.2023.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/20/2023] [Accepted: 06/19/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Bronchiectasis, a previously neglected condition, now has renewed research interest. There are a few systematic reviews that have reported on the economic and societal burden of bronchiectasis in adults, but none have reported on children. We undertook this systematic review to estimate the economic burden of bronchiectasis in children and adults. RESEARCH QUESTION What is the health care resource utilization and economic burden of bronchiectasis in adults and children? STUDY DESIGN AND METHODS We performed a systematic review identifying publications from Embase, PubMed, Web of Science, Cochrane (trials, reviews, and editorials), and EconLit about the economic burden and health care utilization in adults and children with bronchiectasis between January 1, 2001, and October 10, 2022. We used a narrative synthesis approach and estimated aggregate costs for several countries. RESULTS We identified 53 publications reporting on the economic burden and/or health care utilization of people with bronchiectasis. Total annual health care costs per adult patient ranged from 2021 $3,579 to $82,545 USD and were predominantly driven by hospitalization costs. Annual indirect costs including lost income because of illness (reported in only five studies) ranged from $1,311 to $2,898 USD. Total health care costs in children with bronchiectasis were $23,687 USD annually in the one study that estimated them. Additionally, one publication found that children with bronchiectasis missed 12 school days per year. We estimated aggregate annual health care costs for nine countries, ranging from $101.6 million per year in Singapore to $14.68 billion per year in the United States. We also estimated the aggregate cost of bronchiectasis in Australian children to be $17.77 million per year. INTERPRETATION This review highlights the substantial economic burden of bronchiectasis for patients and health systems. To our knowledge, it is the first systematic review to include the costs for children with bronchiectasis and their families. Future research to examine the economic impact of bronchiectasis in children and economically disadvantaged communities, and to further understand the indirect burden of bronchiectasis on individuals and the community, is needed.
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Affiliation(s)
- Jack M Roberts
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Vikas Goyal
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia; Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE) and Menzies School of Health Research, Darwin, NT, Australia
| | - Nitin Kapur
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Pieter C Goeminne
- Department of Respiratory and Sleep Medicine, VITAZ, Sint-Niklaas, Belgium
| | | | - Julie M Marchant
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia; Digital Health and Informatics Directorate, Metro South Health, Brisbane, QLD, Australia.
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Demetriou EA, Boulton KA, Thapa R, Sun C, Gilroy J, Bowden MR, Guastella A. Burden of paediatric hospitalisations to the health care system, child and family: a systematic review of Australian studies (1990-2022). THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 40:100878. [PMID: 38116503 PMCID: PMC10730319 DOI: 10.1016/j.lanwpc.2023.100878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/15/2023] [Accepted: 08/03/2023] [Indexed: 12/21/2023]
Abstract
Background Paediatric hospitalisations represent a significant cost to the health system and cause significant burden to children and their families. Understanding trends in hospitalisation costs can assist with health planning and support strategies across stakeholders. The objective of this systematic review is to examine the trends in costs and burden of paediatric hospitalisations in Australia to help inform policy and promote the well-being of children and their families. Methods Electronic data sources (Embase, Medline, Web of Science, PSYCH-Info, CINAHL and Scopus) were searched from 1990 until December 2022. Any quantitative or qualitative studies conducted in Australian tertiary hospitals were included in the review. Eligible studies were those that included paediatric (<18 years) hospitalisations and reported on economic and/or non-economic costs for the child, family unit and/or health system. Study quality and risk of bias for each study were assessed with the Joanna Briggs Critical Appraisal Tools. We present a summary of the findings of the hospitalisation burden across major diagnostic admission categories and for the child and family unit. The systematic review was registered with Prospero (ID: CRD42021276202). Findings The review summarises a total of 88 studies published between 1990 and December 2022. Overall, the studies identified that paediatric hospitalisations incur significant financial costs, which have not shown significant reductions over time. In-patient direct hospital costs varied depending on the type of treatment and diagnostic condition. The costs per-case were found to range from just below AUD$2000 to AUD$20,000 or more. The financial burden on the family unit included loss of productivity, transport and travel costs. Some studies reported estimates of these costs upward of AUD$500 per day. Studies evaluating 'hospital in the home' options identified significant benefits in reducing hospitalisations and costs without compromising care. Interpretation Increasing focus on alternative models of care may help alleviate the significant costs associated with paediatric hospitalisation. Funding This research was supported by Hospitals United for Sick Kids (formerly Curing Homesickness).
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Affiliation(s)
- Eleni Andrea Demetriou
- Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 2050, Australia
| | - Kelsie Ann Boulton
- Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 2050, Australia
| | - Rinku Thapa
- Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 2050, Australia
| | - Carter Sun
- Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 2050, Australia
| | | | - Michael Russell Bowden
- Mental Health Branch, NSW Health, Sydney Children's Hospitals Network, Discipline of Psychiatry, Westmead Clinical School and The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Adam Guastella
- Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 2050, Australia
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Mi Y, Xue Z, Qu S, Yin Y, Huang J, Kou R, Wang X, Luo S, Li W, Tang Y. The economic burden of coronary heart disease in mainland China. Public Health 2023; 224:140-151. [PMID: 37797560 DOI: 10.1016/j.puhe.2023.08.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/06/2023] [Accepted: 08/25/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES The aim of this study was to systematically evaluate the current economic burden of coronary heart disease (CHD) in mainland China and provide a reference for the formulation of policies to reduce the economic burden of CHD. STUDY DESIGN A systematic literature review was conducted of empirical studies on the economic burden of CHD over the past 20 years. METHODS PubMed, Web of Science, Embase, China Knowledge Resource Integrated Database and the WANFANG database were comprehensively searched for relevant articles published between 1 January 2000 and 22 December 2021. Content analysis was used to extract the data, and Stata 17.0 software was used for analysis. The median values were used to describe trends. RESULTS A total of 35 studies were included in this review. The annual median per-capita hospitalisation expense and the average expense per hospitalisation were $3544.40 ($891.64-$18,371.46) and $5407.34 ($1139.93-$8277.55), respectively. The median ratio on medical consumables expenses, drug expenses, medical examination expenses and treatment expenses were 41.59% (12.40%-63.73%), 26.90% (7.30%-60.00%), 9.45% (1.65%-33.40%) and 10.10% (2.36%-66.00%), respectively. The median per-capita hospitalisation expense in the eastern, central and western regions were $9374.45 ($2056.13-$18,371.46), $4751.5 ($2951.95-$8768.93) and $3251.25 ($891.64-$13,986.38), respectively. The median average expense per hospitalisation in the eastern and central regions were $6177.15 ($1679.15-$8277.55) and $1285.49 ($1239.93-$2197.36), respectively. The median average length of stay in the eastern, central and western regions were 9.3 days, 15.2 days and 16.1 days, respectively. CONCLUSIONS The economic burden of CHD is more severe in mainland China than in developed countries, especially in terms of the direct economic burden. In terms of the types of direct medical expenses, a proportion of medical examination expenses, treatment expenses and drug expenses were lowest in the eastern region, but medical consumables expenses were the highest in this region. This study provides guidance for the formulation of policies to reduce the economic burden of CHD in mainland China.
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Affiliation(s)
- Y Mi
- School of Public Health, Weifang Medical University, Weifang, PR China
| | - Z Xue
- School of Public Health, Weifang Medical University, Weifang, PR China
| | - S Qu
- School of Public Health, Weifang Medical University, Weifang, PR China
| | - Y Yin
- Qingdao Stomatological Hospital, Qingdao, PR China
| | - J Huang
- School of Public Health, Weifang Medical University, Weifang, PR China
| | - R Kou
- School of Public Health, Weifang Medical University, Weifang, PR China
| | - X Wang
- Personnel Department, Weifang Medical University, Weifang, PR China
| | - S Luo
- School of Management, Weifang Medical University, Weifang, PR China
| | - W Li
- School of Public Health, Weifang Medical University, Weifang, PR China.
| | - Y Tang
- School of Public Health, Weifang Medical University, Weifang, PR China.
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Mazulov O, Powell Z, Powell E, Bush A, Chang AB, Kantar A, Grimwood K, Karadag B. World Bronchiectasis Day: It is time for global action to promote equity of care. Pediatr Pulmonol 2023. [PMID: 37171114 DOI: 10.1002/ppul.26467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/29/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Oleksandr Mazulov
- Department of Pulmonology, Vinnytsya Children's Regional Hospital, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Zena Powell
- European Lung Foundation Bronchiectasis Paediatric Patient Advisory Group, Sheffield, UK
| | - Ed Powell
- European Lung Foundation Bronchiectasis Paediatric Patient Advisory Group, Sheffield, UK
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial School of Medicine, London, UK
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy
| | - Keith Grimwood
- Departments of Infectious Disease and Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University Faculty of Medicine, Istanbul, Turkey
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9
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Chang AB, Bell SC, Byrnes CA, Dawkins P, Holland AE, Kennedy E, King PT, Laird P, Mooney S, Morgan L, Parsons M, Poot B, Toombs M, Torzillo PJ, Grimwood K. Thoracic Society of Australia and New Zealand (TSANZ) position statement on chronic suppurative lung disease and bronchiectasis in children, adolescents and adults in Australia and New Zealand. Respirology 2023; 28:339-349. [PMID: 36863703 PMCID: PMC10947421 DOI: 10.1111/resp.14479] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/18/2023] [Indexed: 03/04/2023]
Abstract
This position statement, updated from the 2015 guidelines for managing Australian and New Zealand children/adolescents and adults with chronic suppurative lung disease (CSLD) and bronchiectasis, resulted from systematic literature searches by a multi-disciplinary team that included consumers. The main statements are: Diagnose CSLD and bronchiectasis early; this requires awareness of bronchiectasis symptoms and its co-existence with other respiratory diseases (e.g., asthma, chronic obstructive pulmonary disease). Confirm bronchiectasis with a chest computed-tomography scan, using age-appropriate protocols and criteria in children. Undertake a baseline panel of investigations. Assess baseline severity, and health impact, and develop individualized management plans that include a multi-disciplinary approach and coordinated care between healthcare providers. Employ intensive treatment to improve symptom control, reduce exacerbation frequency, preserve lung function, optimize quality-of-life and enhance survival. In children, treatment also aims to optimize lung growth and, when possible, reverse bronchiectasis. Individualize airway clearance techniques (ACTs) taught by respiratory physiotherapists, encourage regular exercise, optimize nutrition, avoid air pollutants and administer vaccines following national schedules. Treat exacerbations with 14-day antibiotic courses based upon lower airway culture results, local antibiotic susceptibility patterns, clinical severity and patient tolerance. Patients with severe exacerbations and/or not responding to outpatient therapy are hospitalized for further treatments, including intravenous antibiotics and intensive ACTs. Eradicate Pseudomonas aeruginosa when newly detected in lower airway cultures. Individualize therapy for long-term antibiotics, inhaled corticosteroids, bronchodilators and mucoactive agents. Ensure ongoing care with 6-monthly monitoring for complications and co-morbidities. Undertake optimal care of under-served peoples, and despite its challenges, delivering best-practice treatment remains the overriding aim.
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Affiliation(s)
- Anne B. Chang
- Australian Centre for Health Services InnovationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Department of Respiratory & Sleep MedicineQueensland Children's HospitalBrisbaneQueenslandAustralia
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health ResearchCharles Darwin UniversityDarwinNorthern TerritoryAustralia
| | - Scott C. Bell
- Thoracic MedicineThe Prince Charles HospitalBrisbaneQueenslandAustralia
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
- Translational Research InstituteBrisbaneQueenslandAustralia
| | - Catherine A. Byrnes
- Department of PaediatricsUniversity of AucklandAucklandNew Zealand
- Starship Children's HospitalAucklandNew Zealand
| | - Paul Dawkins
- Department of Respiratory MedicineMiddlemore HospitalAucklandNew Zealand
- University of AucklandAucklandNew Zealand
| | - Anne E. Holland
- Department of PhysiotherapyAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Institute for Breathing and SleepHeidelbergVictoriaAustralia
| | - Emma Kennedy
- College of Medicine and Public HealthFlinders UniversityDarwinNorthern TerritoryAustralia
- Board of Northern Territory General Practice Education LtdDarwinNorthern TerritoryAustralia
- Pandanus Medical NTMillnerNorthern TerritoryAustralia
| | - Paul T. King
- Departments of Respiratory and Sleep Medicine and Medicine, Monash Medical CentreMonash UniversityMelbourneVictoriaAustralia
| | - Pamela Laird
- Department PhysiotherapyPerth Children's HospitalPerthWestern AustraliaAustralia
- Wal‐yan Respiratory Research CentreTelethon Kids InstitutePerthWestern AustraliaAustralia
- Department of Paediatrics, School of MedicineUniversity of WAPerthWestern AustraliaAustralia
| | - Sarah Mooney
- Department of Respiratory MedicineMiddlemore HospitalAucklandNew Zealand
- School of Clinical SciencesAUT UniversityAucklandNew Zealand
| | - Lucy Morgan
- Department of Respiratory Medicine at Concord and Nepean HospitalsSchool of Medicine, Faculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
| | - Marianne Parsons
- Representative of Parent Advisory Group, NHMRC Centre of Research Excellence in Paediatric Bronchiectasis, Cough and Airways Research Group, Australian Centre for Health Services InnovationQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Betty Poot
- Respiratory DepartmentHutt Hospital, Te Whatu Ora Capital, Coast and Hutt ValleyLower HuttNew Zealand
- School of Nursing Midwifery, and Health PracticeVictoria University of WellingtonWellingtonNew Zealand
| | - Maree Toombs
- School of Public HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Paul J. Torzillo
- Nganampa Health CouncilAlice SpringsNorthwest TerritoriesAustralia
- Royal Prince Alfred HospitalUniversity of SydneySydneyNew South WalesAustralia
| | - Keith Grimwood
- School of Medicine and Dentistry, Menzies Health Institute QueenslandGriffith UniversitySouthportQueenslandAustralia
- Departments of Infectious Diseases and PaediatricsGold Coast HealthSouthportQueenslandAustralia
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10
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Gong T, Wang X, Li S, Zhong L, Zhu L, Luo T, Tian D. Global research status and trends of bronchiectasis in children from 2003 to 2022: A 20-year bibliometric analysis. Front Pediatr 2023; 11:1095452. [PMID: 36816374 PMCID: PMC9936077 DOI: 10.3389/fped.2023.1095452] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
Background This study aims to analyze the research hotspots, evolution, and developing trends in pediatric bronchiectasis over the past 20 years using bibliometric analysis and visualization tools to identify potential new research directions. Methods Publications related to bronchiectasis in children were retrieved from the Web of Science Core Collection (WoSCC) database from 2003 to 2022. Knowledge maps were performed through VOSviewer1.6.18 and CiteSpace6.1 R2. Results A total of 2,133 publications were searched, while only 1,351 original articles written in English between 2003 and 2022 were incorporated. After removing duplicates, we finally included 1,350 articles published by 6,593 authors from 1,865 institutions in 80 countries/regions in 384 different academic journals with an average citation frequency of 24.91 times. The number of publications shows an extremely obvious binomial growth trend. The majority of publications originated from the United States, Australia, and England. The institutes in Australia, especially Charles Darwin University, published the most articles associated with pediatric bronchiectasis. In addition, Pediatric Pulmonology was the most published journal. In terms of authors, Chang AB was the most productive author, while Gangell CL had the highest average citation frequency. The five keywords that have appeared most frequently during the last two decades were "children," "cystic fibrosis," "bronchiectasis," "ct," and "pulmonary-function." According to keyword analysis, early diagnosis and intervention and optimal long-term pediatric-specific management were the most concerned topics for researchers. Conclusion This bibliometric analysis indicates that bronchiectasis in children has drawn increasing attention in the last two decades as its recognition continues to rise, providing scholars in the field with significant information on current topical issues and research frontiers.
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Affiliation(s)
| | | | | | | | | | | | - Daiyin Tian
- Department of Respiratory Disease, Children’s Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
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11
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Vicendese D, Yerkovich S, Grimwood K, Valery PC, Byrnes CA, Morris PS, Dharmage SC, Chang AB. Long-term Azithromycin in Children With Bronchiectasis Unrelated to Cystic Fibrosis: Treatment Effects Over Time. Chest 2023; 163:52-63. [PMID: 36030839 DOI: 10.1016/j.chest.2022.08.2216] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/11/2022] [Accepted: 08/12/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Following evidence from randomized controlled trials, patients with bronchiectasis unrelated to cystic fibrosis receive long-term azithromycin to reduce acute respiratory exacerbations. However, the period when azithromycin is effective and which patients are likely to most benefit remain unknown. RESEARCH QUESTIONS (i) What is the period after its commencement when azithromycin is most effective? and (ii) Which factors may modify azithromycin effects? STUDY DESIGN AND METHODS A secondary analysis was conducted of our previous randomized controlled trial involving 89 indigenous children with bronchiectasis unrelated to cystic fibrosis. Semi-parametric Poisson regression identified the azithromycin efficacy period. Multivariable Poisson regression identified factors that modify azithromycin effect. RESULTS Azithromycin was associated with fewer exacerbations per child-week during weeks 4 through 96, with the most effective period observed between weeks 17 and 62. Eleven factors were associated with different azithromycin effects; four were significant at the P < .05 level. Compared with their counterparts, higher reduction in exacerbations was observed in children with nasopharyngeal carriage of bacterial pathogens (incidence rate ratio [IRR] = 0.81 [95% CI, 0.57-1.14] vs 0.29 [0.20-0.44]; P < .001); New Zealand children (IRR = 0.73 [0.51-1.03] vs 0.39 [0.28-0.55]; P = .012); and those with higher weight-for-height z scores (interaction IRR = 0.82 [0.67-0.99]; P = .044). Compared with their counterparts, lower reduction was observed in those born preterm (IRR = 0.41 [0.30-0.55] vs 0.74 [0.49-1.10]; P = .012). INTERPRETATION Regular azithromycin is best used for at least 17 weeks and up to 62 weeks, as these periods provide maximum benefit for indigenous children with bronchiectasis unrelated to cystic fibrosis. Several factors modified azithromycin benefits; however, these traits need confirmation in larger studies before being adopted into clinical practice. CLINICAL TRIALS REGISTRATION Australian New Zealand Clinical Trials Registry; ACTRN12610000383066.
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Affiliation(s)
- Don Vicendese
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; School of Engineering and Mathematical Sciences, La Trobe University, Bundoora, VIC, Australia.
| | - Stephanie Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Child Health Division, Menzies School of Health Research, Darwin, NT, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Keith Grimwood
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Departments of Infectious Diseases, and Paediatrics, Gold Coast Health, Gold Coast, QLD, Australia
| | - Patricia C Valery
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Catherine A Byrnes
- Department of Paediatrics, University of Auckland, Auckland, New Zealand; Paediatric Respiratory Medicine, Starship Children's Health & Kidz First Hospital, Auckland, New Zealand
| | - Peter S Morris
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, NT, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Child Health Division, Menzies School of Health Research, Darwin, NT, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
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12
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Mocelin HT, Fischer GB, Piccini JD, Baú R, Andrade CF, Lukrafka JL. Surgical treatment of non-cystic fibrosis bronchiectasis in children and adolescents: A review. Paediatr Respir Rev 2022:S1526-0542(22)00073-2. [PMID: 36528553 DOI: 10.1016/j.prrv.2022.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To discuss surgery for non-cystic fibrosis [CF] bronchiectasis in children and adolescents. SOURCES Non-systematic review including articles in English, mainly from the last 5 years. SUMMARY OF FINDINGS In this review, we present that in low- and middle-income countries [LMIC] clinical treatment fails in around 20% of cases due to low socioeconomic status and poor adherence. This causes the disease to progress and require surgery. We emphasize that the indications for surgery are not well defined and must be considered on an individual basis. The surgical treatment of bronchiectasis in children may be indicated in selected cases; especially in localized disease with frequent exacerbations despite an optimized clinical approach. Surgery can improve quality of life [QoL] and reduce exacerbations. It has few postoperative complications and low morbidity and mortality. Finally, we propose an algorithm for managing bronchiectasis, which takes into account LMIC settings with limited resources. CONCLUSION We conclude that in LMICs, surgery is a treatment strategy for selected children/adolescents with bronchiectasis.
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Affiliation(s)
- Helena Teresinha Mocelin
- Department of Paediatrics, Federal University of Health Sciences of Porto Alegre (UFCSPA), Brazil; Pediatric Pulmonology Section, Hospital da Criança Santo Antônio, Porto Alegre, Brazil.
| | - Gilberto Bueno Fischer
- Department of Paediatrics, Federal University of Health Sciences of Porto Alegre (UFCSPA), Brazil; Pediatric Pulmonology Section, Hospital da Criança Santo Antônio, Porto Alegre, Brazil.
| | - Júlia Danezi Piccini
- Pediatric Pulmonology Section, Hospital da Criança Santo Antônio, Porto Alegre, Brazil
| | - Renata Baú
- Thoracic Surgeon, Hospital de Clínicas de Porto Alegre, Brazil
| | - Cristiano Feijó Andrade
- Thoracic Surgeon, Hospital de Clínicas de Porto Alegre, Brazil; Thoracic Surgeon, Hospital da Criança Santo Antônio, Porto Alegre, Brazil
| | - Janice Luisa Lukrafka
- Department of Physiotherapy, Federal University of Health Sciences of Porto Alegre (UFCSPA), Brazil.
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13
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Chang AB, Boyd J, Bush A, Hill AT, Powell Z, Zacharasiewicz A, Alexopoulou E, Chalmers JD, Collaro AJ, Constant C, Douros K, Fortescue R, Griese M, Grigg J, Hector A, Karadag B, Mazulov O, Midulla F, Moeller A, Proesmans M, Wilson C, Yerkovich ST, Kantar A, Grimwood K. Quality standards for managing children and adolescents with bronchiectasis: an international consensus. Breathe (Sheff) 2022; 18:220144. [PMID: 36865655 PMCID: PMC9973502 DOI: 10.1183/20734735.0144-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
The global burden of bronchiectasis in children and adolescents is being recognised increasingly. However, marked inequity exists between, and within, settings and countries for resources and standards of care afforded to children and adolescents with bronchiectasis compared with those with other chronic lung diseases. The European Respiratory Society (ERS) clinical practice guideline for the management of bronchiectasis in children and adolescents was published recently. Here we present an international consensus of quality standards of care for children and adolescents with bronchiectasis based upon this guideline. The panel used a standardised approach that included a Delphi process with 201 respondents from the parents and patients' survey, and 299 physicians (across 54 countries) who care for children and adolescents with bronchiectasis. The seven quality standards of care statements developed by the panel address the current absence of quality standards for clinical care related to paediatric bronchiectasis. These internationally derived, clinician-, parent- and patient-informed, consensus-based quality standards statements can be used by parents and patients to access and advocate for quality care for their children and themselves, respectively. They can also be used by healthcare professionals to advocate for their patients, and by health services as a monitoring tool, to help optimise health outcomes.
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Affiliation(s)
- Anne B. Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia,NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia,Corresponding author: Anne B. Chang ()
| | | | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial School of Medicine, London, UK
| | - Adam T. Hill
- Dept of Respiratory Medicine, Royal Infirmary, Edinburgh, UK,University of Edinburgh, Edinburgh, UK
| | - Zena Powell
- European Lung Foundation Bronchiectasis Paediatric Patient Advisory Group
| | - Angela Zacharasiewicz
- Department of Pediatrics, and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Klinik Ottakring, Vienna, Austria
| | - Efthymia Alexopoulou
- 2nd Radiology Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - James D. Chalmers
- College of Medicine, University of Dundee, Dundee, UK,Ninewells Hospital and Medical School, Dundee, UK
| | - Andrew J. Collaro
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia
| | - Carolina Constant
- Department of Pediatrics, Hospital de Santa Maria and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Konstantinos Douros
- Allergology and Pulmonology Unit, 3rd Paediatric Dept, National and Kapodistrian University of Athens, Athens, Greece
| | - Rebecca Fortescue
- Population Health Research Institute, St George's University of London, London, UK
| | - Matthias Griese
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Andreas Hector
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland, Childhood Research Center, Zurich, Switzerland
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Oleksandr Mazulov
- National Pirogov Medical University, Vinnytsya, Ukraine,Vinnytsya Children's Regional Hospital, Pulmonology Dept, Vinnytsya, Ukraine
| | - Fabio Midulla
- Department of Maternal Science, Sapienza University of Rome, Rome, Italy
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland, Childhood Research Center, Zurich, Switzerland
| | - Marijke Proesmans
- Department of Pediatrics, Pediatric Pulmonology, University Hospital of Leuven, Leuven, Belgium
| | - Christine Wilson
- Department of Physiotherapy, Queensland Children's Hospital, Brisbane, Australia
| | - Stephanie T. Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia,NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy,Both authors contributed equally to this article as senior authors
| | - Keith Grimwood
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, Australia,Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Southport, Australia,Both authors contributed equally to this article as senior authors
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14
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Mao Y, Chen L, He T, Li J, Zou A, Li F, Chen F, Fan B, Ni W, Xiao W, You H, Fu W. Daily versus three-times-weekly azithromycin in Chinese patients with non-cystic fibrosis bronchiectasis: protocol for a prospective, open-label and randomised controlled trial. BMJ Open 2022; 12:e059186. [PMID: 35803624 PMCID: PMC9272127 DOI: 10.1136/bmjopen-2021-059186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Non-cystic fibrosis bronchiectasis (NCFB) brought a heavy healthcare burden worldwide. Macrolide maintenance therapy was proved to be helpful in reducing exacerbation of NCFB. However, the optimal dosing regimens of macrolides have not been determined, and its efficacy in Chinese NCFB population has not been validated. This protocol describes a head-to-head clinical trial designed to compare the efficacy of two dosing regimens of azithromycin in Chinese NCFB population. METHODS AND ANALYSIS This prospective, open-label and randomised controlled trial will be conducted in the First People's Hospital of Jiashan, China. Eligible patients with high-resolution CT defined NCFB will be randomly divided into three groups, which will receive either 250 mg daily azithromycin, or 500 mg three-times-weekly azithromycin or no treatment for 6 months. They will be followed up for another 6 months without treatment. The primary outcome is the mean rate of protocol-defined pulmonary exacerbation at 6 months. ETHICS AND DISSEMINATION Ethical approval was obtained from the First People's Hospital of Jiashan Ethics Committee. The findings will be disseminated in peer-reviewed publications. TRIAL REGISTRATION NUMBER ChiCTR2100052906.
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Affiliation(s)
- Yanxiong Mao
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Lan Chen
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Ting He
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Jing Li
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Aiping Zou
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Feng Li
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Fei Chen
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Bo Fan
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Weihao Ni
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Wei Xiao
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Huimin You
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Wenjiang Fu
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
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15
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Chang AB, Boyd J, Bush A, Hill AT, Powell Z, Zacharasiewicz A, Alexopoulou E, Chalmers JD, Collaro AJ, Constant C, Douros K, Fortescue R, Griese M, Grigg J, Hector A, Karadag B, Mazulov O, Midulla F, Moeller A, Proesmans M, Wilson C, Yerkovich ST, Kantar A, Grimwood K. International consensus statement on quality standards for managing children/adolescents with bronchiectasis from the ERS CRC Child-BEAR-Net. Eur Respir J 2022; 59:59/6/2200264. [PMID: 35680151 DOI: 10.1183/13993003.00264-2022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/19/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia .,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.,NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | | | - Andrew Bush
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial School of Medicine, London, UK
| | - Adam T Hill
- Dept of Respiratory Medicine, Royal Infirmary, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
| | - Zena Powell
- European Lung Foundation bronchiectasis paediatric patient advisory group
| | - Angela Zacharasiewicz
- Dept of Pediatrics, and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Klinikum Ottakring, Vienna, Austria
| | - Efthymia Alexopoulou
- 2nd Radiology Dept, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - James D Chalmers
- College of Medicine, University of Dundee, Dundee, UK.,Ninewells Hospital and Medical School, Dundee, UK
| | - Andrew J Collaro
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia
| | - Carolina Constant
- Dept of Pediatrics, Hospital de Santa Maria and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Konstantinos Douros
- Allergology and Pulmonology Unit, 3rd Paediatric Dept, National and Kapodistrian University of Athens, Athens, Greece
| | - Rebecca Fortescue
- Population Health Research Institute, St George's University of London, London, UK
| | - Matthias Griese
- Dept of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Andreas Hector
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland.,Childhood Research Center, Zurich, Switzerland
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Oleksandr Mazulov
- National Pirogov Medical University, Vinnytsya, Ukraine.,Pulmonology Dept, Vinnytsya Children's Regional Hospital, Vinnytsya, Ukraine
| | - Fabio Midulla
- Dept of Maternal Science, Sapienza University of Rome, Rome, Italy
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland.,Childhood Research Center, Zurich, Switzerland
| | - Marijke Proesmans
- Dept of Pediatrics, Pediatric Pulmonology, University Hospital of Leuven, Leuven, Belgium
| | - Christine Wilson
- Dept of Physiotherapy, Queensland Children's Hospital, Brisbane, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.,NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy.,Co-senior author
| | - Keith Grimwood
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, Australia.,Depts of Infectious Diseases and Paediatrics, Gold Coast Health, Southport, Australia.,Co-senior author
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16
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Chang AB, Morgan LC, Duncan EL, Chatfield MD, Schultz A, Leo PJ, McCallum GB, McInerney-Leo AM, McPhail SM, Zhao Y, Kruljac C, Smith-Vaughan HC, Morris PS, Marchant JM, Yerkovich ST, Cook AL, Wurzel D, Versteegh L, O'Farrell H, McElrea MS, Fletcher S, D'Antoine H, Stroil-Salama E, Robinson PJ, Grimwood K. Reducing exacerbations in children and adults with primary ciliary dyskinesia using erdosteine and/or azithromycin therapy (REPEAT trial): study protocol for a multicentre, double-blind, double-dummy, 2×2 partial factorial, randomised controlled trial. BMJ Open Respir Res 2022; 9:9/1/e001236. [PMID: 35534039 PMCID: PMC9086630 DOI: 10.1136/bmjresp-2022-001236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/20/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Primary ciliary dyskinesia (PCD) is a rare, progressive, inherited ciliopathic disorder, which is incurable and frequently complicated by the development of bronchiectasis. There are few randomised controlled trials (RCTs) involving children and adults with PCD and thus evidence of efficacy for interventions are usually extrapolated from people with cystic fibrosis. Our planned RCT seeks to address some of these unmet needs by employing a currently prescribed (but unapproved for long-term use in PCD) macrolide antibiotic (azithromycin) and a novel mucolytic agent (erdosteine). The primary aim of our RCT is to determine whether regular oral azithromycin and erdosteine over a 12-month period reduces acute respiratory exacerbations among children and adults with PCD. Our primary hypothesis is that: people with PCD who regularly use oral azithromycin and/or erdosteine will have fewer exacerbations than those receiving the corresponding placebo medications. Our secondary aims are to determine the effect of the trial medications on PCD-specific quality-of-life (QoL) and other clinical outcomes (lung function, time-to-next exacerbation, hospitalisations) and nasopharyngeal bacterial carriage and antimicrobial resistance. Methods and analysis We are currently undertaking a multicentre, double-blind, double-dummy RCT to evaluate whether 12 months of azithromycin and/or erdosteine is beneficial for children and adults with PCD. We plan to recruit 104 children and adults with PCD to a parallel, 2×2 partial factorial superiority RCT at five sites across Australia. Our primary endpoint is the rate of exacerbations over 12 months. Our main secondary outcomes are QoL, lung function and nasopharyngeal carriage by respiratory bacterial pathogens and their associated azithromycin resistance. Ethics and dissemination Our RCT is conducted in accordance with Good Clinical Practice and the Australian legislation and National Health and Medical Research Council guidelines for ethical conduct of Research, including that for First Nations Australians. Trial registration number ACTRN12619000564156.
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Affiliation(s)
- Anne B Chang
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia .,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Lucy C Morgan
- Department of Health and Ageing, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Emma L Duncan
- School of Life Course & Population Sciences, King's College London, London, UK.,Department of Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Australian Translational Genomics Centre, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mark D Chatfield
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - André Schultz
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Paul J Leo
- Australian Translational Genomics Centre, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Gabrielle B McCallum
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Aideen M McInerney-Leo
- University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Yuejen Zhao
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Health Gains Planning, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | | | - Heidi C Smith-Vaughan
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Peter S Morris
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Anne L Cook
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Danielle Wurzel
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Lesley Versteegh
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Hannah O'Farrell
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Margaret S McElrea
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Sabine Fletcher
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Heather D'Antoine
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Enna Stroil-Salama
- Lung Foundation of Australia, Metro South Health, Brisbane, Queensland, Australia.,Brisbane South Palliative Care Collaborative, Metro South, Queensland Health, Brisbane, Queensland, Australia
| | - Phil J Robinson
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Keith Grimwood
- Departments of Infectious Disease and Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia.,School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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17
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Kularatna S, Senanayake S, Parsonage W, Jun D, McPhail S. Economic burden of patients living with heart disease in the last years of life in Australia: a retrospective analysis using linked data. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:333-341. [PMID: 33724356 DOI: 10.1093/ehjqcco/qcab006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/04/2021] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
AIMS People living with heart disease are at elevated risk of hospitalization during the last years of their life. The aim of this study was to describe hospitalization-related usage patterns, and associated cost burden, for patients living with heart disease in the last 6 years of their life. METHODS AND RESULTS The study was an observational cohort study, using routinely collected and linked data from hospital admission (HA), emergency department (ED) presentation and death registry data in Queensland, Australia. The study sample included 1000 randomly selected patients who died in 2017 due to any cause who had been living with heart disease for at least the prior 6 years. The two main outcomes of interest in this study were cost of HAs and cost of ED presentation in the last 6 years before death. Total cost was calculated as a sum of direct and overhead costs from each of the hospital presentations. The mean HA per patient in the sixth year, second year, and last year prior to death was 5.3, 6.6, and 7.5, respectively, with a similar pattern observed for ED presentations. The associated costs per patient from HA followed a similar trajectory increasing gradually from $17 711 in the sixth year to $26 658 in the second last year prior to death. A similar pattern was observed for ED presentation costs. CONCLUSION The large increase cost in the last year of life was primarily attributable to higher treatment cost per HA at end of life.
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Affiliation(s)
- Sanjeewa Kularatna
- Queensland University of Technology (QUT), Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, 60 Musk Ave, Kelvin Grove, QLD 4059, Australia
| | - Sameera Senanayake
- Queensland University of Technology (QUT), Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, 60 Musk Ave, Kelvin Grove, QLD 4059, Australia
| | - William Parsonage
- Queensland University of Technology (QUT), Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, 60 Musk Ave, Kelvin Grove, QLD 4059, Australia
- Royal Brisbane and Women's Hospital, Metro North Health, Herston, QLD 4059, Australia
| | - Deokhoon Jun
- Clinical Informatics Directorate, Metro South Health, Brisbane, Australia
| | - Steven McPhail
- Queensland University of Technology (QUT), Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, 60 Musk Ave, Kelvin Grove, QLD 4059, Australia
- Clinical Informatics, Metro South Health, Brisbane, QLD, Australia
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18
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Goyal V, Chang AB. Bronchiectasis in Childhood. Clin Chest Med 2022; 43:71-88. [DOI: 10.1016/j.ccm.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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19
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Marsh RL, Binks MJ, Smith-Vaughan HC, Janka M, Clark S, Richmond P, Chang AB, Thornton RB. Prevalence and subtyping of biofilms present in bronchoalveolar lavage from children with protracted bacterial bronchitis or non-cystic fibrosis bronchiectasis: a cross-sectional study. THE LANCET MICROBE 2022; 3:e215-e223. [DOI: 10.1016/s2666-5247(21)00300-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 10/19/2022] Open
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20
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Chang AB, Grimwood K, Boyd J, Fortescue R, Powell Z, Kantar A. Management of children and adolescents with bronchiectasis: summary of the ERS clinical practice guideline. Breathe (Sheff) 2022; 17:210105. [PMID: 35035559 PMCID: PMC8753694 DOI: 10.1183/20734735.0105-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 12/16/2022] Open
Abstract
Bronchiectasis, characterised by chronic wet/productive cough with recurrent respiratory exacerbations and abnormal bronchial dilatation on computed tomography scans, remains an increasingly recognised but often neglected chronic pulmonary disorder in children and adolescents. An early diagnosis combined with optimal management offers the prospect, at least in some patients, of curing a condition previously considered irreversible. However, unlike in adults, until now no international paediatric guidelines existed. The recently published European Respiratory Society clinical practice guidelines for the management of children and adolescents with bronchiectasis attempts to address this clinical information gap. The guidelines were formulated by panel members comprised of experts from several relevant health fields, the European Lung Foundation and parents of children with bronchiectasis. Systematic reviews and the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach guided the nature and strength of recommendations. The recommendations are grouped into clinically relevant topics: diagnosis, evaluating for underlying causes, defining exacerbations, management, systematic care, monitoring, reversibility and prevention. The guidelines seek to achieve: 1) optimal lung growth, 2) preserved lung function, 3) enhanced quality of life, 4) minimal exacerbations, 5) few or no complications, and 6) if possible, reversal of lung injury for each child/adolescent with bronchiectasis. This review presents example cases that highlight the recommendations of the clinical practice guidelines. An international guideline for managing children/adolescents with bronchiectasis is now availablehttps://bit.ly/3A3XYnN
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Keith Grimwood
- Depts of Infectious Disease and Paediatrics, Gold Coast Health, Southport, Australia.,School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Southport, Australia
| | | | - Rebecca Fortescue
- Population Health Research Institute, St George's University of London, London, UK
| | - Zena Powell
- European Lung Foundation bronchiectasis paediatric patient advisory group, Sheffield, UK
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy
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21
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Marchant JM, Chang AB, Schutz KL, Versteegh L, Cook A, Roberts J, Morris PS, Yerkovich ST, McCallum GB. Utility of a personalised Bronchiectasis Action Management Plan (BAMP) for children with bronchiectasis: protocol for a multicentre, double-blind parallel, superiority randomised controlled trial. BMJ Open 2021; 11:e049007. [PMID: 34937712 PMCID: PMC8704965 DOI: 10.1136/bmjopen-2021-049007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Bronchiectasis is no longer considered rare or irreversible in children, yet it remains relatively under-researched and neglected in respiratory health globally. Bronchiectasis (including chronic suppurative lung disease) causes substantial morbidity for patients and significant impact on caregivers, especially during acute respiratory exacerbations. In other chronic respiratory diseases (eg, asthma), empowering consumers with an individualised plan for management of acute exacerbations improves clinical outcomes. However, in the absence of any such data specific to bronchiectasis, action management plans are rarely currently used in children or adults with bronchiectasis. We hypothesise that providing an individualised bronchiectasis action management plan (BAMP) to children with bronchiectasis reduces non-scheduled doctor consultations, compared with not having a BAMP. METHODS AND ANALYSIS This multicentre, parallel, double-blind, randomised trial involving three urban Australian hospitals commenced in June 2018 and will include 198 children, aged <19 years with bronchiectasis who had 2 or more exacerbations in the previous 18 months. Children will be randomised to having an individualised BAMP or standard care (a decoy clinic letter). Primary caregivers will then be followed up monthly for 12 months. The primary outcome is the rate of acute non-scheduled doctor visits for respiratory exacerbations by 12 months. The main secondary outcomes are cough-specific quality of life scores at 6 and 12 months, overall exacerbation rate over 12 months, and proportion of children who received timely influenza vaccination by 30 May annually. ETHICS AND DISSEMINATION The Human Research Ethics Committees of the Northern Territory Department of Health and Menzies School of Heath Research and Queensland Children's Hospital approved the study. The results of the trial will be submitted for publication and the BAMP made available free online. TRIAL REGISTRATION NUMBER Australia and New Zealand Clinical Trials Register ACTRN12618000604202.
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Affiliation(s)
- Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kobi L Schutz
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Lesley Versteegh
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anne Cook
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jack Roberts
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter S Morris
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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22
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Marchant JM, Cook AL, Roberts J, Yerkovich ST, Goyal V, Arnold D, O’Farrell HE, Chang AB. Burden of Care for Children with Bronchiectasis from Parents/Carers Perspective. J Clin Med 2021; 10:jcm10245856. [PMID: 34945152 PMCID: PMC8707334 DOI: 10.3390/jcm10245856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/16/2022] Open
Abstract
Bronchiectasis is a neglected chronic respiratory condition. In children optimal appropriate management can halt the disease process, and in some cases reverse the radiological abnormality. This requires many facets, including parental/carer bronchiectasis-specific knowledge, for which there is currently no such published data. Further, the importance of patient voices in guiding clinical research is becoming increasingly appreciated. To address these issues, we aimed to describe the voices of parents of children with bronchiectasis relating to (a) burden of illness and quality of life (QoL), (b) their major worries/concerns and (c) understanding/management of exacerbations. The parents of 152 children with bronchiectasis (median age = 5.8 years, range 3.5-8.4) recruited from the Queensland Children's Hospital (Australia) completed questionnaires, including a parent-proxy cough-specific QoL. We found that parents of children with bronchiectasis had impaired QoL (median 4.38, range 3.13-5.63) and a high disease burden with median 7.0 (range 4.0-10.0) doctor visits in 12-months. Parental knowledge varied with only 41% understanding appropriate management of an exacerbation. The highest worry/concern expressed were long-term effects (n = 42, 29.8%) and perceived declining health (n = 36, 25.5%). Our study has highlighted the need for improved education, high parental burden and areas of concern/worry which may inform development of a bronchiectasis-specific paediatric QoL tool.
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Affiliation(s)
- Julie M. Marchant
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Correspondence:
| | - Anne L. Cook
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
| | - Jack Roberts
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
| | - Stephanie T. Yerkovich
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia
| | - Vikas Goyal
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
| | - Daniel Arnold
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia
| | - Hannah E. O’Farrell
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia
| | - Anne B. Chang
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia
- School of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
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23
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Chang AB, Boyd J, Bush A, Grimwood K, Hill AT, Powell Z, Yerkovich S, Zacharasiewicz A, Kantar A. Children's Bronchiectasis Education Advocacy and Research Network (Child-BEAR-Net): an ERS Clinical Research Collaboration on improving outcomes of children and adolescents with bronchiectasis. Eur Respir J 2021; 58:58/4/2101657. [PMID: 34675034 DOI: 10.1183/13993003.01657-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Anne B Chang
- Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia .,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Australia
| | | | - Andrew Bush
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial School of Medicine, London, UK
| | - Keith Grimwood
- Depts of Infectious Disease and Paediatrics, Gold Coast Health, Southport, Australia.,School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Southport, Australia
| | - Adam T Hill
- Dept of Respiratory Medicine, Royal Infirmary and University of Edinburgh, Edinburgh, UK
| | - Zena Powell
- European Lung Foundation bronchiectasis paediatric patient advisory group
| | - Stephanie Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Australia
| | - Angela Zacharasiewicz
- Dept of Pediatrics, and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Klinikum Ottakring, Vienna, Austria
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy
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24
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Kantar A. Bronchiectasis in Australian First Nations Children: Looking Inside the Gunyah. Chest 2021; 160:1153-1154. [PMID: 34625157 DOI: 10.1016/j.chest.2021.06.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Ahmad Kantar
- Pediatric Asthma and Cough Centre, Gruppo Ospedaliero San Donato, Bergamo; and the Università Vita Salute San Raffaele, Milano.
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25
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Kapur N, Stroil-Salama E, Morgan L, Yerkovich S, Holmes-Liew CL, King P, Middleton P, Maguire G, Smith D, Thomson R, McCallum G, Owens L, Chang AB. Factors associated with "Frequent Exacerbator" phenotype in children with bronchiectasis: The first report on children from the Australian Bronchiectasis Registry. Respir Med 2021; 188:106627. [PMID: 34592538 DOI: 10.1016/j.rmed.2021.106627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In adults with bronchiectasis, multicentre data advanced the field including disease characterisation and derivation of phenotypes such as 'frequent exacerbator (FE)' (≥3 exacerbations/year). However, paediatric cohorts are largely limited to single centres and no scientifically derived phenotypes of paediatric bronchiectasis yet exists. Using paediatric data from the Australian Bronchiectasis Registry (ABR), we aimed to: (a) describe the clinical characteristics and compare Indigenous with non-Indigenous children, and (b) determine if a FE phenotype can be identified and if so, its associated factors. METHODS We retrieved data of children (aged <18-years) with radiologically confirmed bronchiectasis, enrolled between March 2016-March 2020. RESULTS Across five sites, 540 children [288 Indigenous; median age = 8-years (IQR 6-11)] were included. Baseline characteristics revealed past infection/idiopathic was the commonest (70%) underlying aetiology, most had cylindrical bronchiectasis and normal spirometry. Indigenous children (vs. non-Indigenous) had significantly more environmental tobacco smoke exposure (84% vs 32%, p < 0.0001) and lower birth weight (2797 g vs 3260 g, p < 0.0001). FE phenotype present in 162 (30%) children, was associated with being younger (ORadjusted = 0.85, 95%CI 0.81-0.90), more recent diagnosis of bronchiectasis (ORadjusted = 0.67; 95%CI 0.60-0.75), recent hospitalization (ORadj = 4.51; 95%CI 2.45-8.54) and Pseudomonas aeruginosa (PsA) infection (ORadjusted = 2.43; 95%CI 1.01-5.78). The FE phenotype were less likely to be Indigenous (ORadjusted = 0.14; 95%CI 0.03-0.65). CONCLUSION Even within a single country, the characteristics of children with bronchiectasis differ among cohorts. A paediatric FE phenotype exists and is characterised by being younger with a more recent diagnosis, PsA infection and previous hospitalization. Prospective data to consolidate our findings characterising childhood bronchiectasis phenotypes are required.
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Affiliation(s)
- Nitin Kapur
- Department of Respiratory & Sleep Medicine, Queensland Children's Hospital and Faculty of Medicine, University of Queensland, QLD, Australia.
| | | | - Lucy Morgan
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Stephanie Yerkovich
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Australia
| | - Chien-Li Holmes-Liew
- Department of Thoracic Medicine, Royal Adelaide Hospital, South Australia, Australia
| | - Paul King
- Monash Respiratory and Sleep Medicine, Monash Medical Centre, VIC, Australia
| | - Peter Middleton
- Department of Respiratory & Sleep Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - Graeme Maguire
- Western Clinical School, University of Melbourne, Melbourne, VIC, Australia
| | - Daniel Smith
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Rachel Thomson
- Department of Respiratory Medicine, Greenslopes Private Hospital and Gallipoli Medical Research Institute, University of Queensland, Greenslopes, QLD, Australia
| | - Gabrielle McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Louisa Owens
- Department of Respiratory Medicine, Sydney Children's Hospital, NSW, Australia
| | - Anne B Chang
- Department of Respiratory & Sleep Medicine, Queensland Children's Hospital and Faculty of Medicine, University of Queensland, QLD, Australia; Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Australia
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26
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Prime SJ, Carter HE, McPhail SM, Petsky HL, Chang AB, Graves N, Marchant JM. Chronic wet cough in Australian children: Societal costs and quality of life. Pediatr Pulmonol 2021; 56:2707-2716. [PMID: 33939893 DOI: 10.1002/ppul.25438] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/13/2021] [Accepted: 04/12/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Children with chronic wet cough regularly use the health system, experience considerable variability in care, have reduced quality of life (QoL), and, left untreated, poorer health outcomes. Despite this, little is known about the associated economic burden. This study aimed to quantify the cost of chronic wet cough among Australian children from the perspectives of families and the health system. METHODS A cost of illness study was conducted at the Queensland Children's Hospital, Brisbane, using data on 91 children newly referred to a respiratory specialist between July 2015 and January 2017 with a history of chronic wet cough (>4 weeks) of unknown etiology. Administrative and parent-reported data were used to estimate costs (reported in 2019 Australian Dollars [AUD]) for up to 12 months before and following initial pulmonology consultation. QoL was assessed for the same periods. RESULTS Mean cost per child-month during the average 9.8 months of observation preceding pulmonology consultation was AUD689 (95% confidence interval [CI] 534-844) increasing to AUD1339 (95% CI 1051-1628) during the average 11.9 months following pulmonology consultation. This translated to a total of AUD1.9 million across the study period, with families bearing 26.4% of costs. Aspiration and bronchiectasis were associated with higher total costs. For all etiologies, cough-specific QoL improved following pulmonology consultation, while direct medical costs declined. CONCLUSION Childhood chronic wet cough is associated with substantial societal costs. The observed cost decrease after specialist diagnosis suggests that early referral to a respiratory specialist may have economic benefits, in addition to the known health benefits.
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Affiliation(s)
- Samantha J Prime
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Hannah E Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Clinical Informatics Directorate, Metro South Health, Woolloongabba, Queensland, Australia
| | - Helen L Petsky
- School of Nursing and Midwifery, Griffith University and Menzies Health Institute Queensland, Brisbane, Queensland, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Nicholas Graves
- Health Service and Systems Research Program, Duke-NUS Medical School, Singapore
| | - Julie M Marchant
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
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27
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Chang AB, Boyd J, Bell L, Goyal V, Masters IB, Powell Z, Wilson C, Zacharasiewicz A, Alexopoulou E, Bush A, Chalmers JD, Fortescue R, Hill AT, Karadag B, Midulla F, McCallum GB, Snijders D, Song WJ, Tonia T, Grimwood K, Kantar A. Clinical and research priorities for children and young people with bronchiectasis: an international roadmap. ERJ Open Res 2021; 7:00122-2021. [PMID: 34291113 PMCID: PMC8287136 DOI: 10.1183/23120541.00122-2021] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/20/2021] [Indexed: 12/14/2022] Open
Abstract
The global burden of children and young people (CYP) with bronchiectasis is being recognised increasingly. They experience a poor quality of life and recurrent respiratory exacerbations requiring additional treatment, including hospitalisation. However, there are no published data on patient-driven clinical needs and/or research priorities for paediatric bronchiectasis. Parent/patient-driven views are required to understand the clinical needs and research priorities to inform changes that benefit CYP with bronchiectasis and reduce their disease burden. The European Lung Foundation and the European Respiratory Society Task Force for paediatric bronchiectasis created an international roadmap of clinical and research priorities to guide, and as an extension of, the clinical practice guideline. This roadmap was based on two global web-based surveys. The first survey (10 languages) was completed by 225 respondents (parents of CYP with bronchiectasis and adults with bronchiectasis diagnosed in childhood) from 21 countries. The parent/patient survey encompassed both clinical and research priorities. The second survey, completed by 258 health practitioners from 54 countries, was limited to research priorities. The two highest clinical needs expressed by parents/patients were: having an action management plan for flare-ups/exacerbations and access to physiotherapists. The two highest health practitioners’ research priorities related to eradication of airway pathogens and optimal airway clearance techniques. Based on both surveys, the top 10 research priorities were derived, and unanimous consensus statements were formulated from these priorities. This document addresses parents'/patients' clinical and research priorities from both the parents'/patients' and clinicians' perspectives and will help guide research and clinical efforts to improve the lives of people with bronchiectasis. This document is an international roadmap on parents’/patients’ clinical and research priorities from both the parents’/patients’ and clinicians’ perspectives to help guide research and clinical efforts to improve the lives of people with bronchiectasishttps://bit.ly/3xoonwi
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | | | - Leanne Bell
- European Lung Foundation Bronchiectasis Paediatric Patient Advisory Group, Sheffield, UK
| | - Vikas Goyal
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - I Brent Masters
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Zena Powell
- European Lung Foundation Bronchiectasis Paediatric Patient Advisory Group, Sheffield, UK
| | - Christine Wilson
- Dept of Physiotherapy, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Angela Zacharasiewicz
- Dept of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Vienna, Austria
| | - Efthymia Alexopoulou
- 2nd Radiology Dept, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Andrew Bush
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial School of Medicine, London, UK
| | - James D Chalmers
- College of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Rebecca Fortescue
- Population Health Research Institute, St George's University of London, London, UK
| | - Adam T Hill
- Dept of Respiratory Medicine, Royal Infirmary and University of Edinburgh, Edinburgh, UK
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Fabio Midulla
- Dept of Maternal Science, Sapienza University of Rome, Rome, Italy
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | | | - Woo-Jung Song
- Dept of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Keith Grimwood
- Depts of Infectious Disease and Paediatrics, Gold Coast Health, Southport, Queensland, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.,These authors contributed equally as senior authors
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Ponte San Pietro, Bergamo, Italy.,These authors contributed equally as senior authors
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28
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Chang AB, Fortescue R, Grimwood K, Alexopoulou E, Bell L, Boyd J, Bush A, Chalmers JD, Hill AT, Karadag B, Midulla F, McCallum GB, Powell Z, Snijders D, Song WJ, Tonia T, Wilson C, Zacharasiewicz A, Kantar A. Task Force report: European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis. Eur Respir J 2021; 58:13993003.02990-2020. [PMID: 33542057 DOI: 10.1183/13993003.02990-2020] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 12/21/2020] [Indexed: 11/05/2022]
Abstract
There is increasing awareness of bronchiectasis in children and adolescents, a chronic pulmonary disorder associated with poor quality-of-life for the child/adolescent and their parents, recurrent exacerbations and costs to the family and health systems. Optimal treatment improves clinical outcomes. Several national guidelines exist, but there are no international guidelines.The European Respiratory Society (ERS) Task Force for the management of paediatric bronchiectasis sought to identify evidence-based management (investigation and treatment) strategies. It used the ERS standardised process that included a systematic review of the literature and application of the GRADE approach to define the quality of the evidence and level of recommendations.A multidisciplinary team of specialists in paediatric and adult respiratory medicine, infectious disease, physiotherapy, primary care, nursing, radiology, immunology, methodology, patient advocacy and parents of children/adolescents with bronchiectasis considered the most relevant clinical questions (for both clinicians and patients) related to managing paediatric bronchiectasis. Fourteen key clinical questions (7 "Patient, Intervention, Comparison, Outcome" [PICO] and 7 narrative) were generated. The outcomes for each PICO were decided by voting by the panel and parent advisory group.This guideline addresses the definition, diagnostic approach and antibiotic treatment of exacerbations, pathogen eradication, long-term antibiotic therapy, asthma-type therapies (inhaled corticosteroids, bronchodilators), mucoactive drugs, airway clearance, investigation of underlying causes of bronchiectasis, disease monitoring, factors to consider before surgical treatment and the reversibility and prevention of bronchiectasis in children/adolescents. Benchmarking quality of care for children/adolescents with bronchiectasis to improve clinical outcomes and evidence gaps for future research could be based on these recommendations.
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Affiliation(s)
- Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Rebecca Fortescue
- Population Health Research Institute, St George's University of London, London, United Kingdom
| | - Keith Grimwood
- Departments of Infectious Disease and Paediatrics, Gold Coast Health, Southport, Queensland, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Southport, Queensland, Australia
| | - Efthymia Alexopoulou
- 2nd Radiology Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Leanne Bell
- European Lung Foundation bronchiectasis paediatric patient advisory group, Alnwick, United Kingdom
| | | | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial School of Medicine, London, UK
| | - James D Chalmers
- College of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Adam T Hill
- Dept of Respiratory Medicine, Royal Infirmary and University of Edinburgh, Edinburgh, UK
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Fabio Midulla
- Department of Maternal Science, Sapienza University of Rome, Rome, Italy
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Zena Powell
- European Lung Foundation bronchiectasis paediatric patient advisory group, Alnwick, United Kingdom
| | - Deborah Snijders
- Dipartimento Salute della Donna e del Bambino, Università degli Studi di Padova, Padova, Italy
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Christine Wilson
- Department of Physiotherapy, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Angela Zacharasiewicz
- Department of Pediatrics, and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Klinikum Ottakring Vienna, Wien, Austria
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Ponte San Pietro-Bergamo, Bergamo, Italy
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29
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Gao YH, Chalmers JD. Counting the cost of bronchiectasis. Respirology 2020; 25:1223-1224. [PMID: 32608039 DOI: 10.1111/resp.13888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Yong-Hua Gao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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