Targeted evidence-based care in bronchiectasis in a regional centre: a treatable traits approach to improving clinical and implementation outcomes

Abstract

Bronchiectasis is a syndrome that develops from a complex interaction of pathophysiological mechanisms, where permanent, abnormal airway dilation is the defining feature. Symptoms, recurrent exacerbations and hospitalisation are key factors determining the severity of bronchiectasis. Exacerbations impact health-related quality of life and disease progression, with frequent exacerbations associated with a higher risk of hospitalisation and mortality.

National and international guidelines in bronchiectasis outline the current evidence-based interventions for bronchiectasis. However, it is increasingly recognised that the co-existence of bronchiectasis with other respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma, along with the large number of possible comorbid conditions, adds further complexity to management. It is difficult for management guidelines to address the individualised application required, in the presence of complex and unique clinical presentations. Perhaps due to these factors, adherence to guideline recommendations is reported as low in bronchiectasis, resulting in sub-optimal treatment outcomes.

New treatment approaches have been proposed in other chronic respiratory diseases, which account for the heterogeneity of clinical presentations. Such approaches are focused on identifying treatable targets or traits of respiratory disease through a structured assessment, and the prioritisation of traits for treatment together with the patient.

While treatable traits have been described in bronchiectasis, the approach has not yet been implemented and evaluated in clinical practice. With the known clinical heterogeneity and reported low adherence to guideline-informed care, it is important to test approaches that further individualise care. The treatable traits approach may offer a model that can improve health outcomes in people with bronchiectasis, with interventions that are guided by the patients’ priorities.