The Australian journal of rural health · 2018
Bronchiectasis in the Kimberley region of Western Australia.
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Barton Justin, Scott Lydia, Maguire Graeme
Аннотация
OBJECTIVE: To review the work-up and inpatient management of non-cystic fibrosis bronchiectasis exacerbations against best practice guidelines in the Kimberley, a remote region of Western Australia, with the ultimate goal of improving treatment in the region.^ DESIGN: Retrospective cohort study and audit of remote adult bronchiectasis hospital admissions between 2011 and 2016.
SETTING: Remote hospital inpatients.
PARTICIPANTS: Thirty-two patients and 110 hospital admissions were included. Patients were ≥15 years old, had computed tomography confirmed bronchiectasis and at least one hospital admission for acute respiratory illness prior to January 2011.
MAIN OUTCOMES MEASURED: The 5-year mortality and compliance to a Lung Foundation position statement on non-cystic fibrosis bronchiectasis which suggests investigating for an underlying cause at diagnosis and during exacerbations prolonged antibiotics (10-14 days) and prolonged hospital admissions (≥7 days) are required.
RESULTS: The overall 5-year mortality was 21.8%, with the median age at death of 37 years (interquartile range, 27-63). The median duration of hospital admission was shorter than the recommended 3 days (interquartile range, 2-5) with 11 of 100 (11%) patients admitted for ≥7 days. The median duration of antibiotics was also shorter than the recommended 7 days (interquartile range, 4-10), with 31 of the 98 (32%) patients prescribed ≥10 days and 6 of the 98 (6%) prescribed ≥14 days of therapy.
CONCLUSION: We found under-treatment and under-investigation of non-cystic fibrosis bronchiectasis in the Kimberley region. Five-year mortality was high, consistent with other rural Australian Indigenous cohorts.§ Following this audit, a strategy to improve awareness, as well as update and promote regional guidelines has been developed.
SETTING: Remote hospital inpatients.
PARTICIPANTS: Thirty-two patients and 110 hospital admissions were included. Patients were ≥15 years old, had computed tomography confirmed bronchiectasis and at least one hospital admission for acute respiratory illness prior to January 2011.
MAIN OUTCOMES MEASURED: The 5-year mortality and compliance to a Lung Foundation position statement on non-cystic fibrosis bronchiectasis which suggests investigating for an underlying cause at diagnosis and during exacerbations prolonged antibiotics (10-14 days) and prolonged hospital admissions (≥7 days) are required.
RESULTS: The overall 5-year mortality was 21.8%, with the median age at death of 37 years (interquartile range, 27-63). The median duration of hospital admission was shorter than the recommended 3 days (interquartile range, 2-5) with 11 of 100 (11%) patients admitted for ≥7 days. The median duration of antibiotics was also shorter than the recommended 7 days (interquartile range, 4-10), with 31 of the 98 (32%) patients prescribed ≥10 days and 6 of the 98 (6%) prescribed ≥14 days of therapy.
CONCLUSION: We found under-treatment and under-investigation of non-cystic fibrosis bronchiectasis in the Kimberley region. Five-year mortality was high, consistent with other rural Australian Indigenous cohorts.§ Following this audit, a strategy to improve awareness, as well as update and promote regional guidelines has been developed.