Self-management for non-cystic fibrosis bronchiectasis: Cochrane Systematic Review

Kelly, Carol and Spencer, Sally and Grundy, Seamus and Lynes, Dave and Evans, David John William and Gudur, Sharada and Milan, Stephen James (2017) Self-management for non-cystic fibrosis bronchiectasis: Cochrane Systematic Review. In: Br, 2017-12-06 - 2017-12-08, Queen Elizabeth II Centre.

Abstract

BackgroundThe aims of therapeutic management for non-cystic fibrosis (non-CF) bronchiectasis are: preservation of lung function, reduction of symptoms and exacerbations, minimise complications, and improve quality of life. Self-management interventions are beneficial in the management of other airways diseases and has been identified as a research priority for bronchiectasis. ObjectivesTo assess the efficacy, cost-effectiveness and adverse effects of self-management interventions for adults and children with non-CF bronchiectasis. MethodsCochrane Airways Group's Specialised Register, ClinicalTrials.gov and the World Health Organization trials portal were searched. We included all parallel and cluster-randomised controlled trials which included adults and children with non-CF bronchiectasis assessing self-management interventions delivered in any form (e.g. mobile device, face-to-face). Two reviewers independently assessed studies for eligibility and quality, and extracted data. ResultsWe identified 53 records and included 2 studies. A total of 84 patients with bronchiectasis were randomised: one RCT of early rehabilitation in adults in two centres in England and one proof-of-concept RCT of an expert patient programme in adults in a single regional respiratory centre in Northern Ireland. Data aggregation was not possible. For primary outcomes, health-related quality of life was reported in both studies but showed no significant benefit. One study reported more deaths in the intervention group compared to the control group, (Intervention: 4 of 8, Control: 2 of 12), though small numbers limit interpretation. Neither study reported data on exacerbations requiring antibiotic therapy. For secondary outcomes, frequency of hospital admissions was reported in one study but was not significantly different between groups. Both studies reported lung function in terms of FEV1 but there were no significant differences between groups (P>0.05). One study reported data on self-efficacy and showed evidence of benefit. Neither study reported data on respiratory symptoms, economic costs or adverse events. Using GRADE guidelines, the outcomes included were judged as very low quality. No trials in children were identified.  ConclusionsThere is insufficient evidence to determine whether self-management has benefits in adults and children with non-CF bronchiectasis. Future studies should more clearly define self-management interventions, control for sources of variability, be adequately powered, measure clinically important outcomes, and include children.