UK’s third most common lung disease is overlooked

Bronchiectasis, first described by Rene Laennec in 1819, is a common long term respiratory condition caused by permanently damaged airways. Over one in 1000 people in the UK now suffer from the disease. There are a variety of causes but the most common risk is previous infection such as whooping cough, pneumonia or tuberculosis. This is the case in up to half of patients, however we cannot identify a specific cause. It leads to people coughing up mucus (also described as sputum or phlegm) on a daily basis and often leads to frequent chest infections. In more severe cases people have problems with wheeze and breathlessness, chest pain and general tiredness.

This condition has received little attention until recent years due to the perception that little can be offered because it is a chronic condition. This has been compounded by the limited research in bronchiectasis to support evidence-based therapies. The British Thoracic Society national audit over the last two years has shown that even in hospitals, many patients are not receiving management as recommended by the British Thoracic Society National Guidelines.

NICE has already been commissioned to produce some quality standards but cannot cover every condition. The British Thoracic Society has taken on this role for bronchiectasis using the NICE model. The Bronchiectasis Quality Standards aim to improve patient care, facilitate more treatment at home and improve patient outcomes.

These standards are intended for:

• Health care professionals to allow decisions to be made about care based on the latest evidence and best practice.
• Patients with bronchiectasis and their carers to enable understanding of what services they should expect from their health and social care provider.
• Service providers to be able to quickly and easily examine the clinical performance of their organisation and assess the standards of care they provide.
• Commissioners so that they can be confident that the services they are purchasing are high quality and cost effective.

There are 11 quality statements [and are focussed on]:

1. Diagnostic accuracy to ensure that the correct people are labelled with this condition.

2. Investigations are carried out for specific treatable causes as they have specific treatments that differ from standard bronchiectasis management, which may alter the prognosis.

3. Regular chest clearance techniques should be taught by a specialist respiratory physiotherapist and patients should be advised of the frequency and duration with which these should be carried out, as this is a key treatment to alleviate symptoms and may reduce chest infections.

4. Rehabilitation is offered to those with significant breathlessness to improve exercise capacity and make them feel better.

5. Monitoring sputum bacteriology-  this is important to monitor both when feeling well and when people have a chest infection which will help guide antibiotic therapy and management and improve the assessment and follow up.

6. Assessment is carried out before and after intravenous antibiotic therapy to allow the patient and clinicians to objectively assess the response and to guide long term management.

7. Inhaled antibiotic service as long term prophylactic treatment may improve symptoms and reduce the number of chest infections.

8. Domiciliary intravenous antibiotic treatment made available for chest infections in selected patients to reduce the need for hospitalisation (which will reduce hospital bed days and the risk of hospital acquired infection) and promote people-centred care allowing delivery of intravenous treatment safely at home.

9. Self-management plan to allow people with bronchiectasis to manage their condition and to recognise, respond to and reduce the occurrence of chest infections.

10. Secondary care follow up as per British Thoracic Society national guidelines as the clinical course and management in such people is complicated and management would be better under a multidisciplinary team led by a respiratory physician.

The British Thoracic Society is calling on policy makers, commissioners and healthcare professionals to stop overlooking this debilitating condition and adopt newly launched quality standards for the disease. The new standards not only aim to improve patient care, facilitate more treatment at home and improve patient outcomes but it is also hoped that their implementation will be cost effective and will save the NHS money.

Recent Posts on Health

• Make AIDS History: Keeping the promise from Gleneagles to Lough Erne
• Living with cervical cancer: 'Had I not delayed screening, it may have been a different story'
• Living with Rett Syndrome: An unconventional day out
• Christian GPs and the morning after pill: Much needed clarification
• Justin Webb on the medical advances in tackling heart disease