Therapeutic Management of Bronchiectasis in Children and Adolescents: A Concise Narrative Review
Abstract
:1. Introduction
2. Materials and Methods
3. Airway Clearance Techniques, Mucoactive Agents and Pulmonary Rehabilitation Programs
4. Bronchodilators and Inhaled Corticosteroids
5. Antibiotics to Prevent Pulmonary Exacerbations
6. Antibiotics for Pathogens Eradication and Treatment of Exacerbations
7. Vaccines
8. Surgery and Transplant
9. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
ACBT | Active Circle of Breathing |
ACT | airway-clearance techniques |
AD | autogenic drainage |
CDC | Center for Disease Control and Prevention |
CF | cystic fibrosis |
ERS | European Respiratory Society |
FeNO | fractional exhaled nitric oxide |
FET | Forced Expiratory Technique |
GAD | gravity-assisted drainage |
ICS | inhaled corticosteroids |
IPPV | Percussive Intrapulmonary Ventilation |
LABA | long-acting β2-agonist |
NTM | nontuberculous mycobacteria |
OPEP | Oscillating Positive Expiratory Pressure |
PCV | pneumococcal conjugate vaccine |
PEP | positive expiratory pressure |
PHiD-CV | 10-valent pneumococcal-H. influenzae protein D conjugate vaccine |
PPV-23 | 23-valent pneumococcal polysaccharide vaccine |
RCT | Randomized Clinical Trial |
RSV | respiratory syncytial virus |
TPEP | temporary positive expiratory pressure |
TSANZ | Thoracic Society of Australia and New Zealand |
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ERS 2021 | TSANZ 2023 |
---|---|
Airway clearance techniques and pulmonary rehabilitation | |
The guidelines recommend that children/adolescents with bronchiectasis are taught and receive regular individualized ACT or maneuvers (strong recommendation, low quality of evidence).
The guidelines suggest that exercise is encouraged on an ongoing basis (conditional recommendation, very low quality of evidence stemming from the narrative review). There is insufficient evidence to make a recommendation for establishing formal exercise and rehabilitation programs. | Individualized ACTs are recommended. Regular physical activity is recommended for children/ adolescents with bronchiectasis. |
Mucoactive agents | |
The guidelines recommend that recombinant human DNase (rhDNase) is not used routinely (strong recommendation, very low quality of evidence). The guidelines suggest that neither bromhexine nor inhaled mannitol nor hypertonic saline are used routinely (conditional recommendation, very low quality of evidence). | Mucoactive agents, including inhaled isotonic saline, hypertonic saline and mannitol, are currently not recommended routinely. |
Bronchodilators and inhaled corticosteroids | |
The guidelines suggest not using ICS with or without LABA routinely in either the short- or long-term, irrespective of stability or exacerbation (conditional recommendation, very low quality of evidence).
The guidelines underline that ICS may be beneficial in those with eosinophilic airway inflammation and that SABA maybe beneficial as pre-airway clearance therapies. | ICS and OCS should not be prescribed routinely in either the short or long-term unless there is an established diagnosis of co-existing asthma and/or eosinophilic airway inflammation. Inhaled bronchodilators should not be prescribed routinely and instead used only on an individual basis (e.g., before undertaking ACTs). |
Antibiotics to prevent pulmonary exacerbations | |
The guidelines recommend treatment with long-term macrolide antibiotics to reduce exacerbations in children and adolescents with bronchiectasis and recurrent exacerbations, particularly in those who have had more than one hospitalized or three or more non-hospitalized exacerbations in the previous 12 months (strong recommendation, low quality of evidence.) | Long-term oral macrolides should be considered for patients with the frequent exacerbator phenotype (≥3 exacerbations requiring antibiotics in the preceding 12-months) and without contraindications to these agents. |
Antibiotics for pathogens eradication and treatment of exacerbations | |
The guidelines suggest eradication therapy following an initial or new detection of P. aeruginosa (conditional recommendation for the intervention, very low quality of evidence).
The guidelines recommend a systemic course of an appropriate antibiotic is used for 14 days in children/adolescents with bronchiectasis and an acute respiratory exacerbation. (strong recommendation, moderate quality of evidence). The guidelines underline that when the exacerbation is severe (e.g., presence of hypoxia) and/or when the child/adolescent does not respond to oral antibiotics, intravenous antibiotics will be needed. | When P. aeruginosa is newly detected, eradication therapy should be offered. In patients not requiring parenteral antibiotics for an acute exacerbation, oral antibiotics are prescribed for at least 14 days based upon available airway microbiology results. Close follow-up to assess treatment response is necessary. Patients failing oral antibiotic therapy for an acute exacerbation should receive intensive airway clearance strategies and parenteral antibiotics based upon the latest lower airway culture results. In children/adolescents, this requires supervised treatment for at least 14 days. |
Vaccines | |
The guidelines suggest that children/adolescents with bronchiectasis are fully immunized according to their
national immunization programs, including pneumococcal and annual seasonal influenza vaccines if these are not part of this program (conditional recommendation, very low quality of evidence stemming from the narrative review). | Vaccinate according to National Immunization Program Schedules, which include pneumococcal and influenza vaccine recommendations for high-risk patients with chronic lung disorders. |
Surgery and transplant | |
Surgery is only considered after maximal medical therapies (e.g., ACT, long-term antibiotics, etc.) have failed and the child/adolescent’s quality of life remains significantly impaired. When contemplated, a multidisciplinary approach is essential, and the decision should be based on the individual’s clinical state and local surgical expertise. (Strong recommendation, very low quality of evidence stemming from the narrative review). | Although surgery is not indicated normally, there may be circumstances requiring assessment by a multidisciplinary team expert in bronchiectasis. |
Bronchiectasis AND airway clearance techniques AND (children AND adolescents), Bronchiectasis AND mucoactive agents AND (children AND adolescents), Bronchiectasis AND pulmonary rehabilitation AND (children AND adolescents), Bronchiectasis AND bronchodilators AND (children AND adolescents), Bronchiectasis AND inhaled corticosteroids AND (children AND adolescents), Bronchiectasis AND inhaled therapy AND (children AND adolescents), Bronchiectasis AND treatment of pulmonary exacerbations AND (children AND adolescents), Bronchiectasis AND pathogens eradication AND (children AND adolescents), Bronchiectasis AND macrolides AND (children AND adolescents), Bronchiectasis AND preventions of exacerbation AND (children AND adolescents), Bronchiectasis AND (S. pneumoniae OR H. influenzae OR influenza virus OR respiratory syncytial virus) vaccines AND (children AND adolescents), Bronchiectasis AND thoracic surgery AND (children AND adolescents), Bronchiectasis AND transplant AND (children AND adolescents) |
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Share and Cite
Faverio, P.; Franco, G.; Landoni, V.; Nadalin, M.; Negri, D.; Tagliabue, A.; Acone, F.; Cattaneo, F.; Cipolla, F.; Vimercati, C.; et al. Therapeutic Management of Bronchiectasis in Children and Adolescents: A Concise Narrative Review. J. Clin. Med. 2024, 13, 4757. https://doi.org/10.3390/jcm13164757
Faverio P, Franco G, Landoni V, Nadalin M, Negri D, Tagliabue A, Acone F, Cattaneo F, Cipolla F, Vimercati C, et al. Therapeutic Management of Bronchiectasis in Children and Adolescents: A Concise Narrative Review. Journal of Clinical Medicine. 2024; 13(16):4757. https://doi.org/10.3390/jcm13164757
Chicago/Turabian StyleFaverio, Paola, Giovanni Franco, Valentina Landoni, Marta Nadalin, Davide Negri, Alessandro Tagliabue, Federica Acone, Francesca Cattaneo, Filippo Cipolla, Chiara Vimercati, and et al. 2024. "Therapeutic Management of Bronchiectasis in Children and Adolescents: A Concise Narrative Review" Journal of Clinical Medicine 13, no. 16: 4757. https://doi.org/10.3390/jcm13164757