Royal Children's Hospital and Queensland Children's Medical Research Institute, Brisbane, QLD, Australia.
Med J Aust. 2010 Sep 20;193(6):356-65. doi: 10.5694/j.1326-5377.2010.tb03949.x.
Consensus recommendations for managing chronic suppurative lung disease (CSLD) and bronchiectasis, based on systematic reviews, were developed for Australian and New Zealand children and adults during a multidisciplinary workshop. The diagnosis of bronchiectasis requires a high-resolution computed tomography scan of the chest. People with symptoms of bronchiectasis, but non-diagnostic scans, have CSLD, which may progress to radiological bronchiectasis. CSLD/bronchiectasis is suspected when chronic wet cough persists beyond 8 weeks. Initial assessment requires specialist expertise. Specialist referral is also required for children who have either two or more episodes of chronic (> 4 weeks) wet cough per year that respond to antibiotics, or chest radiographic abnormalities persisting for at least 6 weeks after appropriate therapy. Intensive treatment seeks to improve symptom control, reduce frequency of acute pulmonary exacerbations, preserve lung function, and maintain a good quality of life. Antibiotic selection for acute infective episodes is based on results of lower airway culture, local antibiotic susceptibility patterns, clinical severity and patient tolerance. Patients whose condition does not respond promptly or adequately to oral antibiotics are hospitalised for more intensive treatments, including intravenous antibiotics. Ongoing treatment requires regular and coordinated primary health care and specialist review, including monitoring for complications and comorbidities. Chest physiotherapy and regular exercise should be encouraged, nutrition optimised, environmental pollutants (including tobacco smoke) avoided, and vaccines administered according to national immunisation schedules. Individualised long-term use of oral or nebulised antibiotics, corticosteroids, bronchodilators and mucoactive agents may provide a benefit, but are not recommended routinely.
基于系统评价,为澳大利亚和新西兰的儿童和成人在一次多学科研讨会上制定了管理慢性化脓性肺病(CSLD)和支气管扩张症的共识建议。支气管扩张症的诊断需要胸部高分辨率计算机断层扫描。有支气管扩张症症状但扫描结果无诊断意义的患者患有 CSLD,其可能进展为放射学支气管扩张症。如果慢性湿咳持续超过 8 周,则怀疑患有 CSLD/支气管扩张症。初步评估需要专家专业知识。如果儿童每年有两次或更多次慢性(>4 周)湿咳,每次都需要抗生素治疗,或者胸部放射异常在适当治疗后至少持续 6 周,也需要专家转诊。强化治疗旨在改善症状控制、减少急性肺部恶化的频率、保持肺功能和维持良好的生活质量。急性感染发作的抗生素选择基于下呼吸道培养、当地抗生素药敏模式、临床严重程度和患者耐受性的结果。对口服抗生素反应不及时或不充分的患者需要住院接受更强化的治疗,包括静脉内抗生素治疗。持续治疗需要定期和协调的初级保健和专家审查,包括监测并发症和合并症。应鼓励进行胸部物理治疗和定期运动,优化营养,避免环境污染物(包括烟草烟雾),并根据国家免疫计划接种疫苗。个体化长期使用口服或雾化抗生素、皮质类固醇、支气管扩张剂和黏液活性剂可能有益,但不建议常规使用。