Marc A Judson1, Haroon Chaudhry, Damian R Compa, Anne E OʼDonnell. 1. Division of Pulmonary and Critical Care Medicine (MAJ, HC, DRC), Albany Medical College, Albany, New York; and Division of Pulmonary (AEO), Critical Care and Sleep Medicine, Georgetown University Hospital, Washington, District of Columbia.
Abstract
BACKGROUND: Presently, there are no medications approved by regulatory bodies for the treatment of noncystic fibrosis bronchiectasis (NCFB). In addition, most techniques/devices to enhance mucociliary clearance in NCFB have not been rigorously evaluated. Therefore, we performed a Delphi study of clinical experts concerning the treatment of NCFB. METHODS: Ten individuals with extensive experience with NCFB participated. Questions were posed concerning pharmacotherapy and mucocilary clearance techniques for NCFB. Iterative questioning and feedback from previous responses were used with an aim to reach consensus. Consensus was defined as ≥70% agreement of the experts. RESULTS: The experts reached consensus concerning several issues including: (1) 10 to 14 days duration of antibiotics for exacerbations of NCFB, (2) Combination antibiotics should not be given for acute exacerbations of NCFB regardless of history of pseudomonas colonization, (3) some type of airway clearance technique should be used for stable NCFB, (4) recommended treatment end points for NCFB include sputum volume, sputum color and exacerbation frequency and (5) recombinant DNA-ase and inhaled corticosteroids should not be routinely used for NCFB. There was some inconsistency in expert responses between the 2 rounds of questions, suggesting that even NCFB experts do not have a completely consistent approach to treatment. CONCLUSIONS: NCFB experts reached consensus on several treatment issues. In the absence of rigorous medical evidence, these data supply support for these approaches. Several questions posed to the experts did not reach consensus. We would classify these issues as "controversial" and suggest that they are important areas for future research.
BACKGROUND: Presently, there are no medications approved by regulatory bodies for the treatment of noncystic fibrosis bronchiectasis (NCFB). In addition, most techniques/devices to enhance mucociliary clearance in NCFB have not been rigorously evaluated. Therefore, we performed a Delphi study of clinical experts concerning the treatment of NCFB. METHODS: Ten individuals with extensive experience with NCFB participated. Questions were posed concerning pharmacotherapy and mucocilary clearance techniques for NCFB. Iterative questioning and feedback from previous responses were used with an aim to reach consensus. Consensus was defined as ≥70% agreement of the experts. RESULTS: The experts reached consensus concerning several issues including: (1) 10 to 14 days duration of antibiotics for exacerbations of NCFB, (2) Combination antibiotics should not be given for acute exacerbations of NCFB regardless of history of pseudomonas colonization, (3) some type of airway clearance technique should be used for stable NCFB, (4) recommended treatment end points for NCFB include sputum volume, sputum color and exacerbation frequency and (5) recombinant DNA-ase and inhaled corticosteroids should not be routinely used for NCFB. There was some inconsistency in expert responses between the 2 rounds of questions, suggesting that even NCFB experts do not have a completely consistent approach to treatment. CONCLUSIONS: NCFB experts reached consensus on several treatment issues. In the absence of rigorous medical evidence, these data supply support for these approaches. Several questions posed to the experts did not reach consensus. We would classify these issues as "controversial" and suggest that they are important areas for future research.
Authors: Hamdan Al-Jahdali; Abdullah Alshimemeri; Abdullah Mobeireek; Amr S Albanna; Nehad N Al Shirawi; Siraj Wali; Khaled Alkattan; Abdulrahman A Alrajhi; Khalid Mobaireek; Hassan S Alorainy; Mohamed S Al-Hajjaj; Anne B Chang; Stefano Aliberti Journal: Ann Thorac Med Date: 2017 Jul-Sep Impact factor: 2.219