Author(s): Kelly C.; Spencer S.; Lynes D.; Grundy S.; Evans D.J.W.; Milan S.J.; Guder S.
Source: Thorax; Dec 2017; vol. 72
Publication Date: Dec 2017
Publication Type(s): Conference Abstract
Available at Thorax – from BMJ Journals – NHS
Abstract:Background The aims of therapeutic management for noncystic fibrosis (non-CF) bronchiectasis are: preservation of lung function, reduction of symptoms and exacerbations and to improve quality of life. Self-management interventions are beneficial in the management of other airway diseases and are a research priority for bronchiectasis. Objectives To assess the efficacy, cost-effectiveness and adverse effects of self-management interventions for adults and children with non-CF bronchiectasis. Methods Cochrane Airways Group’s Specialised Register, ClinicalTrials. gov and the World Health Organisation trials portal were searched. We included all parallel and cluster-randomised controlled trials which included adults and children with non- CF bronchiectasis and assessed self-management interventions delivered in any form (e.g., mobile device, face-to-face) compared with usual care or alternate form of self-management. Two reviewers independently assessed studies for eligibility and quality, and extracted data. Results We identified 53 records and included 2 studies: one RCT of early rehabilitation in adults in two centres in England and one proof-of-concept RCT of an expert patient programme in adults in a single regional respiratory centre in Northern Ireland. A total of 84 adult patients with bronchiectasis were randomised. Data aggregation was not possible. For primary outcomes, health-related quality of life was reported in both studies but showed no significant benefit. One study reported more deaths in the intervention group compared to the control group, (Intervention: 4 of 8, Control: 2 of 12), although small numbers limit interpretation. Neither study reported data on exacerbations requiring antibiotic therapy. For secondary outcomes, frequency of hospital admissions was reported in one study but was not significantly different between groups. Both studies reported lung function in terms of FEV1 and there were no significant differences between groups. One study reported data on self-efficacy and showed evidence of benefit. Neither study reported data on respiratory symptoms, economic costs or adverse events. Using GRADE guidelines, the outcomes included were judged as very low quality. Conclusions There is insufficient evidence to determine whether self-management has benefits in adults and children with non-CF bronchiectasis. Future studies should more clearly define self-management interventions, control for sources of variability, be adequately powered, measure clinically important outcomes, and include children.