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Clinical Outcomes in Relation to Care of a Multidisciplinary Non-Cystic Fibrosis Bronchiectasis Out-Patient Clinic
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A6278 - Clinical Outcomes in Relation to Care of a Multidisciplinary Non-Cystic Fibrosis Bronchiectasis Out-Patient Clinic
Author Block: J. Yuan1, S. Ho2, J. Y. H. Lee1, E. C. Tan3, X. N. Wang4, L. M. Tham4, A. Verma2, S. H. Puah2, J. A. Abisheganaden2, A. Y. H. Lim2; 1Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, 2Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore, 3Physiotherapy, Tan Tock Seng Hospital, Singapore, Singapore, 4Nursing, Tan Tock Seng Hospital, Singapore, Singapore.
Rationale: Non-cystic fibrosis bronchiectasis (NCFB) is a complex inflammatory airway disease with structural airway damage, significant morbidity and mortality. The evidence for improved clinical outcomes from managing patients with CF at ""specialist centers"" is well established. However, the role of ""specialist clinics"" in managing NCFB patients is less clear, and has not been reported from Asia. Our aim was to evaluate the clinical outcome of managing patients with NCFB at a multidisciplinary specialist out-patient clinic (NCFB SOC).
Methods: Patients from the NCFB SOC were divided into two periods. Period A was 12 months before attending the NCFB SOC and patients were managed by a non-bronchiectasis specialist. Period B was 12 months after attending the NCFB SOC and patients were managed by a bronchiectasis specialist, respiratory physiotherapist, and 2 respiratory nurses. We performed a comparison analysis on predicted forced expiratory volume in one second (FEV1), body mass index (BMI), hospital admissions due to acute exacerbations of bronchiectasis, and emergency department (ED) attendances due to acute exacerbation of bronchiectasis between periods A and B. The data on patients’ demographics, sputum microbiology, and co-morbidities were also collated and analyzed.
Results: We studied 74 patients (29 male) with a mean (SD) age of 68 (12). The mean (SD) BMI and percent predicted FEV1 was 20 (5) and 66 (17) respectively. Five patients were current cigarette smokers. Non-tuberculous mycobacterium (NTM) (n=16) was the commonest organism isolated from sputum, followed by Pseudomonas aeruginosa (n=11). The three commonest co-morbidities were hyperlipidaemia, hypertension, and diabetes mellitus. The mean (SD) rate of ED attendance due to bronchiectasis exacerbation was significantly reduced from period A to B [0.3(0.6) vs. 0.1(0.3), p=0.01]. Likewise, the mean (SD) rate of hospital admission due to bronchiectasis exacerbation was significantly reduced from period A to B [1(1.2) vs. 0.5(0.9), p=0.01]. The BMI and percent predicted FEV1 were stable after attending the NCFB for 12 months [(20 vs. 20) and (65% vs. 67%) respectively].
Conclusions: This study demonstrates that managing patients at a NCFB SOC results in a reduction in the rate of ED attendance and hospitalization. A larger cohort study will be required to validate the clinical outcomes of this study in the future.
Author Block: J. Yuan1, S. Ho2, J. Y. H. Lee1, E. C. Tan3, X. N. Wang4, L. M. Tham4, A. Verma2, S. H. Puah2, J. A. Abisheganaden2, A. Y. H. Lim2; 1Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, 2Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore, 3Physiotherapy, Tan Tock Seng Hospital, Singapore, Singapore, 4Nursing, Tan Tock Seng Hospital, Singapore, Singapore.
Rationale: Non-cystic fibrosis bronchiectasis (NCFB) is a complex inflammatory airway disease with structural airway damage, significant morbidity and mortality. The evidence for improved clinical outcomes from managing patients with CF at ""specialist centers"" is well established. However, the role of ""specialist clinics"" in managing NCFB patients is less clear, and has not been reported from Asia. Our aim was to evaluate the clinical outcome of managing patients with NCFB at a multidisciplinary specialist out-patient clinic (NCFB SOC).
Methods: Patients from the NCFB SOC were divided into two periods. Period A was 12 months before attending the NCFB SOC and patients were managed by a non-bronchiectasis specialist. Period B was 12 months after attending the NCFB SOC and patients were managed by a bronchiectasis specialist, respiratory physiotherapist, and 2 respiratory nurses. We performed a comparison analysis on predicted forced expiratory volume in one second (FEV1), body mass index (BMI), hospital admissions due to acute exacerbations of bronchiectasis, and emergency department (ED) attendances due to acute exacerbation of bronchiectasis between periods A and B. The data on patients’ demographics, sputum microbiology, and co-morbidities were also collated and analyzed.
Results: We studied 74 patients (29 male) with a mean (SD) age of 68 (12). The mean (SD) BMI and percent predicted FEV1 was 20 (5) and 66 (17) respectively. Five patients were current cigarette smokers. Non-tuberculous mycobacterium (NTM) (n=16) was the commonest organism isolated from sputum, followed by Pseudomonas aeruginosa (n=11). The three commonest co-morbidities were hyperlipidaemia, hypertension, and diabetes mellitus. The mean (SD) rate of ED attendance due to bronchiectasis exacerbation was significantly reduced from period A to B [0.3(0.6) vs. 0.1(0.3), p=0.01]. Likewise, the mean (SD) rate of hospital admission due to bronchiectasis exacerbation was significantly reduced from period A to B [1(1.2) vs. 0.5(0.9), p=0.01]. The BMI and percent predicted FEV1 were stable after attending the NCFB for 12 months [(20 vs. 20) and (65% vs. 67%) respectively].
Conclusions: This study demonstrates that managing patients at a NCFB SOC results in a reduction in the rate of ED attendance and hospitalization. A larger cohort study will be required to validate the clinical outcomes of this study in the future.
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