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Development of a Primary Care Screening Tool for Bronchiectasis
Description
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A1970 - Development of a Primary Care Screening Tool for Bronchiectasis
Author Block: E. Fardon; Hawkhill Medical Centre, Dundee, United Kingdom.
Rationale
It is believed that the prevalence of bronchiectasis is around 1 in every 1000 patients; Hawkhill Medical Centre has a list size of around 12,000 patients. Our current bronchiectasis register already numbers 37 patients - over 3 times the estimated prevalence. It is likely, therefore, that bronchiectasis is far more prevalent than previously thought. Case-finding for those patients most likely to have bronchiectasis, coupled with appropriate, evidence-based management, can be expected to improve quality of life, as well as reduce secondary care admissions
Methods
A search was made of all adult (age 18 and over) patients prescribed 2 or more courses of antibiotics for respiratory tract infections over the preceding 6 months. Antibiotics of interest were: amoxicillin; doxycycline; clarithromycin, trimethoprim, co-amoxiclav; co-trimoxazole; erythromycin. Patients with severe co-morbid disease; terminal disease; or significant frailty were excluded from the study. All eligible patients were then invited to attend for a 15 minute appointment with a practice nurse, involving completion of a questionnaire (history of severe chest infections; smoking status; other lung conditions; cough and/or sputum); blood tests (inflammatory markers; immunoglobulins; Aspergillus serology); and sputum sampling. A chest X-ray was arranged (if not carried out within the preceding 6 months). Results were collated by a primary care physician, and patients more likely to have bronchiectasis were referred for HRCT scanning, and a specialist respiratory clinic review. Criteria for onward referral were one or more of: chronic daily productive cough; positive sputum sample; abnormal blood results; abnormal chest X-ray
Results
33 patients were invited to see the practice nurse. Of these, 27 attended, and 19 met criteria for further investigations (HRCT) and specialist referral. To date (end of October 2017), 15 HRCT scans have been performed, with 8 confirmed cases of bronchiectasis; 6 cases of other respiratory disease; and one normal scan. 4 patients are awaiting their scans. 4 patients have so far been reviewed by a respiratory specialist
Conclusions
Over 50 % of the HRCT scans carried out so far have demonstrated bronchiectasis. This screening tool therefore provides a simple method for identifying patients who may have undiagnosed bronchiectasis.
Author Block: E. Fardon; Hawkhill Medical Centre, Dundee, United Kingdom.
Rationale
It is believed that the prevalence of bronchiectasis is around 1 in every 1000 patients; Hawkhill Medical Centre has a list size of around 12,000 patients. Our current bronchiectasis register already numbers 37 patients - over 3 times the estimated prevalence. It is likely, therefore, that bronchiectasis is far more prevalent than previously thought. Case-finding for those patients most likely to have bronchiectasis, coupled with appropriate, evidence-based management, can be expected to improve quality of life, as well as reduce secondary care admissions
Methods
A search was made of all adult (age 18 and over) patients prescribed 2 or more courses of antibiotics for respiratory tract infections over the preceding 6 months. Antibiotics of interest were: amoxicillin; doxycycline; clarithromycin, trimethoprim, co-amoxiclav; co-trimoxazole; erythromycin. Patients with severe co-morbid disease; terminal disease; or significant frailty were excluded from the study. All eligible patients were then invited to attend for a 15 minute appointment with a practice nurse, involving completion of a questionnaire (history of severe chest infections; smoking status; other lung conditions; cough and/or sputum); blood tests (inflammatory markers; immunoglobulins; Aspergillus serology); and sputum sampling. A chest X-ray was arranged (if not carried out within the preceding 6 months). Results were collated by a primary care physician, and patients more likely to have bronchiectasis were referred for HRCT scanning, and a specialist respiratory clinic review. Criteria for onward referral were one or more of: chronic daily productive cough; positive sputum sample; abnormal blood results; abnormal chest X-ray
Results
33 patients were invited to see the practice nurse. Of these, 27 attended, and 19 met criteria for further investigations (HRCT) and specialist referral. To date (end of October 2017), 15 HRCT scans have been performed, with 8 confirmed cases of bronchiectasis; 6 cases of other respiratory disease; and one normal scan. 4 patients are awaiting their scans. 4 patients have so far been reviewed by a respiratory specialist
Conclusions
Over 50 % of the HRCT scans carried out so far have demonstrated bronchiectasis. This screening tool therefore provides a simple method for identifying patients who may have undiagnosed bronchiectasis.
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