Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Developing a Diagnostic Bundle for Bronchiectasis in South Korea: A Modified Delphi Consensus Study

  • Choi, Hayoung (Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Lee, Hyun (Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Ra, Seung Won (Division of Pulmonary Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Jang, Jong Geol (Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center) ;
  • Lee, Ji-Ho (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Jhun, Byung Woo (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Hye Yun (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jung, Ji Ye (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Seung Jun (Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital) ;
  • Jo, Kyung-Wook (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Rhee, Chin Kook (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Changwhan (Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine) ;
  • Lee, Sei Won (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Min, Kyung Hoon (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Kwon, Yong-Soo (Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital) ;
  • Kim, Deog Kyeom (Department of Internal Medicine, SMG-SNU Borame Medical Center, Seoul National University College of Medicine) ;
  • Lee, Jin Hwa (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University College of Medicine) ;
  • Park, Yong Bum (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital) ;
  • Chung, Eun Hee (Department of Pediatrics, Chungnam National University College of Medicine) ;
  • Kim, Yae-Jean (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yoo, Kwang Ha (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Oh, Yeon-Mok (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2021.09.08
  • Accepted : 2021.11.07
  • Published : 2022.01.31
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Abstract

Background: Because the etiologies of bronchiectasis and related diseases vary significantly among different regions and ethnicities, this study aimed to develop a diagnostic bundle for bronchiectasis in South Korea. Methods: A modified Delphi method was used to develop expert consensus statements on a diagnostic bundle for bronchiectasis in South Korea. Initial statements proposed by a core panel, based on international bronchiectasis guidelines, were discussed in an online meeting and two email surveys by a panel of experts (≥70% agreement). Results: The study involved 21 expert participants, and 30 statements regarding a diagnostic bundle for bronchiectasis were classified as recommended, conditional, or not recommended. The consensus statements of the expert panel were as follows: A standardized diagnostic bundle is useful in clinical practice; diagnostic tests for specific diseases, including immunodeficiency and allergic bronchopulmonary aspergillosis, are necessary when clinically suspected; initial diagnostic tests, including sputum microbiology and spirometry, are essential in all patients with bronchiectasis, and patients suspected with rare causes such as primary ciliary dyskinesia should be referred to specialized centers. Conclusion: Based on this Delphi survey, expert consensus statements were generated including specific diagnostic, laboratory, microbiological, and pulmonary function tests required to manage patients with bronchiectasis in South Korea.

Keywords

Acknowledgement

We would like to thank Sang Yong Sim, RN (Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center) for assistance with the study.

References

  1. Choi H, Yang B, Nam H, Kyoung DS, Sim YS, Park HY, et al. Population-based prevalence of bronchiectasis and associated comorbidities in South Korea. Eur Respir J 2019;54:1900194. https://doi.org/10.1183/13993003.00194-2019
  2. Kim C, Kim DG. Bronchiectasis. Tuberc Respir Dis 2012;73:249-57. https://doi.org/10.4046/trd.2012.73.5.249
  3. Seitz AE, Olivier KN, Adjemian J, Holland SM, Prevots DR. Trends in bronchiectasis among medicare beneficiaries in the United States, 2000 to 2007. Chest 2012;142:432-9. https://doi.org/10.1378/chest.11-2209
  4. Ringshausen FC, de Roux A, Pletz MW, Hamalainen N, Welte T, Rademacher J. Bronchiectasis-associated hospitalizations in Germany, 2005-2011: a population-based study of disease burden and trends. PLoS One 2013;8:e71109. https://doi.org/10.1371/journal.pone.0071109
  5. Ringshausen FC, de Roux A, Diel R, Hohmann D, Welte T, Rademacher J. Bronchiectasis in Germany: a population-based estimation of disease prevalence. Eur Respir J 2015;46:1805-7. https://doi.org/10.1183/13993003.00954-2015
  6. Quint JK, Millett ER, Joshi M, Navaratnam V, Thomas SL, Hurst JR, et al. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: a population-based cohort study. Eur Respir J 2016;47:186-93. https://doi.org/10.1183/13993003.01033-2015
  7. Yang B, Choi H, Lim JH, Park HY, Kang D, Cho J, et al. The disease burden of bronchiectasis in comparison with chronic obstructive pulmonary disease: a national database study in Korea. Ann Transl Med 2019;7:770. https://doi.org/10.21037/atm.2019.11.55
  8. Choi H, Yang B, Kim YJ, Sin S, Jo YS, Kim Y, et al. Increased mortality in patients with non cystic fibrosis bronchiectasis with respiratory comorbidities. Sci Rep 2021;11:7126. https://doi.org/10.1038/s41598-021-86407-8
  9. Sin S, Yun SY, Kim JM, Park CM, Cho J, Choi SM, et al. Mortality risk and causes of death in patients with non-cystic fibrosis bronchiectasis. Respir Res 2019;20:271. https://doi.org/10.1186/s12931-019-1243-3
  10. Lee H, Choi H, Chalmers JD, Dhar R, Nguyen TQ, Visser SK, et al. Characteristics of bronchiectasis in Korea: first data from the Korean Multicentre Bronchiectasis Audit and Research Collaboration registry and comparison with other international registries. Respirology 2021;26:619-21. https://doi.org/10.1111/resp.14059
  11. Dhar R, Singh S, Talwar D, Mohan M, Tripathi SK, Swarnakar R, et al. Bronchiectasis in India: results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry. Lancet Glob Health 2019;7:e1269-79. https://doi.org/10.1016/S2214-109X(19)30327-4
  12. McShane PJ, Naureckas ET, Tino G, Strek ME. Noncystic fibrosis bronchiectasis. Am J Respir Crit Care Med 2013;188:647-56. https://doi.org/10.1164/rccm.201303-0411CI
  13. McDonnell MJ, Aliberti S, Goeminne PC, Restrepo MI, Finch S, Pesci A, et al. Comorbidities and the risk of mortality in patients with bronchiectasis: an international multicentre cohort study. Lancet Respir Med 2016;4:969-79. https://doi.org/10.1016/S2213-2600(16)30320-4
  14. Hill AT, Sullivan AL, Chalmers JD, De Soyza A, Elborn SJ, Floto AR, et al. British Thoracic Society Guideline for bronchiectasis in adults. Thorax 2019;74:1-69.
  15. Polverino E, Goeminne PC, McDonnell MJ, Aliberti S, Marshall SE, Loebinger MR, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J 2017;50:1700629. https://doi.org/10.1183/13993003.00629-2017
  16. Gao YH, Guan WJ, Liu SX, Wang L, Cui JJ, Chen RC, et al. Aetiology of bronchiectasis in adults: a systematic literature review. Respirology 2016;21:1376-83. https://doi.org/10.1111/resp.12832
  17. Amati F, Simonetta E, Pilocane T, Gramegna A, Goeminne P, Oriano M, et al. Diagnosis and initial investigation of bronchiectasis. Semin Respir Crit Care Med 2021;42:513-24. https://doi.org/10.1055/s-0041-1730892
  18. Dalkey N, Helmer O. An experimental application of the Delphi method to the use of experts. Manag Sci 1963;9:458-67. https://doi.org/10.1287/mnsc.9.3.458
  19. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus G. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006;101:1900-20. https://doi.org/10.1111/j.1572-0241.2006.00630.x
  20. Bennett C, Vakil N, Bergman J, Harrison R, Odze R, Vieth M, et al. Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process. Gastroenterology 2012;143:336-46. https://doi.org/10.1053/j.gastro.2012.04.032
  21. Denning DW, Cadranel J, Beigelman-Aubry C, Ader F, Chakrabarti A, Blot S, et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J 2016;47:45-68. https://doi.org/10.1183/13993003.00583-2015
  22. Araujo D, Shteinberg M, Aliberti S, Goeminne PC, Hill AT, Fardon T, et al. Standardised classification of the aetiology of bronchiectasis using an objective algorithm. Eur Respir J 2017;50:1701289. https://doi.org/10.1183/13993003.01289-2017
  23. Lee H, Choi H, Sim YS, Park S, Kim WJ, Yoo KH, et al. KMBARC registry: protocol for a multicentre observational cohort study on non-cystic fibrosis bronchiectasis in Korea. BMJ Open 2020;10:e034090. https://doi.org/10.1136/bmjopen-2019-034090
  24. Yang B, Ryu J, Kim T, Jo YS, Kim Y, Park HY, et al. Impact of bronchiectasis on incident nontuberculous mcobacterial pulmonary disease: a 10-year national cohort study. Chest 2021;159:1807-11. https://doi.org/10.1016/j.chest.2020.12.020
  25. Jose RJ, Loebinger MR. Clinical and radiological phenotypes and endotypes. Semin Respir Crit Care Med 2021;42:549-55. https://doi.org/10.1055/s-0041-1730894
  26. Aliberti S, Lonni S, Dore S, McDonnell MJ, Goeminne PC, Dimakou K, et al. Clinical phenotypes in adult patients with bronchiectasis. Eur Respir J 2016;47:1113-22. https://doi.org/10.1183/13993003.01899-2015
  27. Lee H, Oh YM. Clinical approach to non-cystic fibrosis bronchiectasis based on recent clinical guideline. Korean J Med 2020;95:141-50. https://doi.org/10.3904/kjm.2020.95.3.141
  28. Choi H, Lee H, Ra SW, Oh YM. Update on pharmacotherapy for adult bronchiectasis. J Korean Med Assoc 2020;63:486-92. https://doi.org/10.5124/jkma.2020.63.8.486
  29. Chalmers JD, Goeminne P, Aliberti S, McDonnell MJ, Lonni S, Davidson J, et al. The bronchiectasis severity index: an international derivation and validation study. Am J Respir Crit Care Med 2014;189:576-85. https://doi.org/10.1164/rccm.201309-1575OC
  30. Lee SY, Lee JS, Lee SW, Oh YM. Effects of treatment with long-acting muscarinic antagonists (LAMA) and long-acting betaagonists (LABA) on lung function improvement in patients with bronchiectasis: an observational study. J Thorac Dis 2021;13:169-77. https://doi.org/10.21037/jtd-20-1282
  31. Kim JH, Yim JJ. Achievements in and challenges of tuberculosis control in South Korea. Emerg Infect Dis 2015;21:1913-20. https://doi.org/10.3201/eid2111.141894