• Megan Rees, Belinda Liu, Amy Pascoe, and Natasha Smallwood.
• Department of Respiratory and Sleep Disorders Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
• Intern Med J. 2023 May 1; 53 (5): 753759753-759.

BackgroundBronchiectasis is a serious, debilitating condition warranting specialist care.AimsTo determine if care provided in a tertiary hospital general respiratory clinic was guideline concordant and to validate the Bronchiectasis Severity Index (BSI) in the Australian context.MethodsA single-centre ambispective study was conducted. The first stage involved a retrospective medical record audit between 1 January 2015 and 31 December 2016. All aspects of bronchiectasis management were reviewed. In the second prospective phase the cohort was followed for 4 years to determine survival and the validity of the BSI determined.ResultsA total of 145 patients was included, with mean age of 65 years (standard deviation = 16.6). The aetiology of bronchiectasis was explicitly documented for 58 (40%) patients, with potential causes identified in another 37 patients. Post-infectious aetiologies were described in 62 (43%) patients. Most patients had lung function testing (n = 142; 97%) and sputum culture results (n = 120; 83%). Long-term antibiotics were prescribed to 49 (34%) patients. Only patients culturing Pseudomonas spp. were prescribed inhaled antibiotics. Documentation regarding essential management recommendations was low, including airway clearance (46%), pneumococcal vaccination (27%) and written action plans (32%). Severe disease was common, with more than one-third (34-48%) having BSI scores >9. One-fifth (21%) of the cohort died during the 4-year follow-up period. The BSI was significantly associated with mortality risk (odds ratio 7.7; 95% confidence interval = 3.1-19.3; P < 0.001).ConclusionOur cohort had a high proportion of patients with severe disease and significant mortality; some, but not all, aspects of recommended care were delivered.© 2022 Royal Australasian College of Physicians.

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