Abstract
Background: Using treatable traits as a management approach in bronchiectasis involves determining identifiable, clinically relevant, measurable and treatable problems to develop a management strategy in collaboration with the patient. Objective: To identify new treatable traits not previously reported in the literature and treatment strategies for new and existing traits that could be implemented in an outpatient clinic or community setting by an allied health professional or nurse in adults with bronchiectasis. Methods: A scoping review was conducted with searches of MEDLINE, CINAHL, AMED, Embase, Cochrane Central Register of Controlled Trials and PsycInfo. The search yielded 9963 articles with 255 articles proceeding to full text review and 114 articles included for data extraction. Results: Sixteen new traits were identified, including fatigue (number of studies with new trait (n) = 13), physical inactivity (n = 13), reduced peripheral muscle power and/or strength (n = 12), respiratory muscle weakness (n = 9) and sedentarism (n = 6). The main treatment strategies for new and existing traits were airway clearance therapy (number of citations (n) = 86), pulmonary rehabilitation (n = 58), inspiratory muscle training (n = 20) and nebulised saline (n = 12). Conclusion: This review identifies several new traits in bronchiectasis and highlights the common treatments for new and existing traits that can be implemented in a treatable traits approach in an outpatient clinic or community setting by an allied health professional or nurse.
| Original language | English |
|---|---|
| Article number | 107503 |
| Number of pages | 18 |
| Journal | Respiratory Medicine |
| Volume | 222 |
| DOIs | |
| Publication status | Published - Feb 2024 |
Keywords
- Airway clearance therapy
- Clinic
- Multidisciplinary team
- Physiotherapy
- Pulmonary rehabilitation
- Respiratory
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In: Respiratory Medicine, Vol. 222, 107503, 02.2024.
Research output: Contribution to journal › Review Article › Research › peer-review
TY - JOUR
T1 - Applying the treatable traits approach in bronchiectasis-A scoping review of traits, measurements and treatments implemented by allied health professionals and nurses
AU - Watson, Kirsty E.
AU - Lee, Annemarie L.
AU - Dwyer, Tiffany J.
AU - McKeough, Zoe J.
N1 - Funding Information: The implementation of a treatable traits approach in bronchiectasis management requires a multidimensional plan [11]. While targeting aetiological conditions is primarily the role of the general practitioner (GP) or respiratory physician, pulmonary, extrapulmonary, environment and lifestyle traits require the expertise of a wider health professional team. The national and international guidelines in bronchiectasis recognise that a multidisciplinary team is required to manage the various clinical presentations and symptoms of the disease [ 4–6]. The identification of traits and the personalisation of care, according to the outcomes prioritised in collaboration with the patient, are the primary focus for management, for example reducing the number of infective exacerbations. Once the treatable traits have been identified and prioritised, strategies can be developed that target the particular trait/s. Treatment strategies that are supported by the national and international bronchiectasis guidelines and can be implemented by an allied health professional or nurse include: airway clearance therapy [ 4–6,16]; a self-management or action plan [5,6]; pulmonary rehabilitation or home exercise prescription [ 4–6,17]; physical activity (PA) and sedentary behaviour (SB) advice according to PA guidelines [6]; education relating to smoking cessation [6], avoidance of environmental airborne pollutants [6] and hydration; management of comorbidities (such as sinusitis and musculoskeletal pain) [5,6]; strategies for breathlessness; and infection control [5,6]. Treatment strategies may target single or multiple traits at the same time.Inspiratory muscle training was the next most frequently reported treatment of new and existing traits, followed by nebulised saline (hypertonic and/or isotonic). Only respiratory muscle weakness had a small number of studies demonstrating a significant improvement following inspiratory muscle training. Inspiratory muscle training is currently recommended as a treatment for respiratory muscle weakness in the ERS bronchiectasis guidelines [4], but is not included as a recommendation for pulmonary rehabilitation programs [30]. Further research is required to inform the broader implementation of inspiratory muscle training as a treatment technique. Nebulised saline is recommended in the management guidelines for bronchiectasis in accordance with stepwise management [5]. The trait of mucus hypersecretion had the most citations reporting a significant improvement following treatment. Current evidence regarding the use of nebulised saline as an adjunct to ACT supports the use of isotonic saline [37], with uncertainty regarding additional benefits with the use of hypertonic saline [38]. In clinical practice, nebulised saline is recommended when sputum is viscous and recurrent infections continue despite optimising ACT [5], and medical guidance is often sought prior to suggesting the nebulisation of hypertonic saline.This scoping review supports providing access to ACT and pulmonary rehabilitation as a minimum standard in adults with bronchiectasis. These treatments have the largest potential to improve multiple traits simultaneously. ACT is recommended to be implemented by a respiratory physiotherapist [4,5]. The delivery of pulmonary rehabilitation requires allied health professionals with experience in exercise prescription [30]. Both treatments can be implemented in different community settings with little or no access to equipment such as airway clearance devices or exercise equipment. While previous reviews of interventions for bronchiectasis found there is limited evidence for individual treatment techniques [34,41,42], the potential of these treatments to target multiple patient traits suggests that implementation of these key strategies may improve outcomes for adults with bronchiectasis. There is a need for implementation research to determine if a treatable traits management strategy will improve clinical outcomes, is easily translatable in resource limited settings and is preferred by adults with bronchiectasis. Publisher Copyright: © 2023 The Author(s)
PY - 2024/2
Y1 - 2024/2
N2 - Background: Using treatable traits as a management approach in bronchiectasis involves determining identifiable, clinically relevant, measurable and treatable problems to develop a management strategy in collaboration with the patient. Objective: To identify new treatable traits not previously reported in the literature and treatment strategies for new and existing traits that could be implemented in an outpatient clinic or community setting by an allied health professional or nurse in adults with bronchiectasis. Methods: A scoping review was conducted with searches of MEDLINE, CINAHL, AMED, Embase, Cochrane Central Register of Controlled Trials and PsycInfo. The search yielded 9963 articles with 255 articles proceeding to full text review and 114 articles included for data extraction. Results: Sixteen new traits were identified, including fatigue (number of studies with new trait (n) = 13), physical inactivity (n = 13), reduced peripheral muscle power and/or strength (n = 12), respiratory muscle weakness (n = 9) and sedentarism (n = 6). The main treatment strategies for new and existing traits were airway clearance therapy (number of citations (n) = 86), pulmonary rehabilitation (n = 58), inspiratory muscle training (n = 20) and nebulised saline (n = 12). Conclusion: This review identifies several new traits in bronchiectasis and highlights the common treatments for new and existing traits that can be implemented in a treatable traits approach in an outpatient clinic or community setting by an allied health professional or nurse.
AB - Background: Using treatable traits as a management approach in bronchiectasis involves determining identifiable, clinically relevant, measurable and treatable problems to develop a management strategy in collaboration with the patient. Objective: To identify new treatable traits not previously reported in the literature and treatment strategies for new and existing traits that could be implemented in an outpatient clinic or community setting by an allied health professional or nurse in adults with bronchiectasis. Methods: A scoping review was conducted with searches of MEDLINE, CINAHL, AMED, Embase, Cochrane Central Register of Controlled Trials and PsycInfo. The search yielded 9963 articles with 255 articles proceeding to full text review and 114 articles included for data extraction. Results: Sixteen new traits were identified, including fatigue (number of studies with new trait (n) = 13), physical inactivity (n = 13), reduced peripheral muscle power and/or strength (n = 12), respiratory muscle weakness (n = 9) and sedentarism (n = 6). The main treatment strategies for new and existing traits were airway clearance therapy (number of citations (n) = 86), pulmonary rehabilitation (n = 58), inspiratory muscle training (n = 20) and nebulised saline (n = 12). Conclusion: This review identifies several new traits in bronchiectasis and highlights the common treatments for new and existing traits that can be implemented in a treatable traits approach in an outpatient clinic or community setting by an allied health professional or nurse.
KW - Airway clearance therapy
KW - Clinic
KW - Multidisciplinary team
KW - Physiotherapy
KW - Pulmonary rehabilitation
KW - Respiratory
UR - http://www.scopus.com/inward/record.url?scp=85181827741&partnerID=8YFLogxK
U2 - 10.1016/j.rmed.2023.107503
DO - 10.1016/j.rmed.2023.107503
M3 - Review Article
C2 - 38141863
AN - SCOPUS:85181827741
SN - 0954-6111
VL - 222
JO - Respiratory Medicine
JF - Respiratory Medicine
M1 - 107503
ER -