Bronchiectasis is a respiratory condition that may occur in both children and adults and is being diagnosed with increasing frequency. It is a long-term condition, where people have recurrent chest infections and symptoms that include cough, mucus production and recurrent flare-ups (exacerbations) that reduce their quality of life. The main aims of management are to reduce the risk of flare-ups using various treatments including antibiotics, inhalers and physiotherapy exercises. It is important for people/carers to stick to their treatments and self-management strategies can help people to do this by teaching them about their condition, available treatments, exercise and what to do if their condition changes. The objective of the review is to assess the effectiveness and value for money of self-management interventions for adults and children with non-cystic fibrosis bronchiectasis.
We assessed the benefits and possible harms of self-management strategies, including patient education, airway clearance techniques, education aimed at increasing adherence to medication, exercise (including pulmonary rehabilitation), and action plans for children and adults with bronchiectasis.
We conducted a search on 13 December 2017 and found just two UK studies that included 84 participants, comparing a self-management approach with normal care for adults with bronchiectasis. One study looked at the impact of an expert patient self-management programme and the other, involving just a small number of participants with bronchiectasis, looked at self-management in combination with exercises to improve lung function. Neither study included children.
Health-related quality of life did not improve in either study. Although there were more deaths in the group receiving self-management in one study, the numbers were very small and we do not know whether the difference is meaningful. The number of admissions to hospital, and lung function showed no benefit from self-management. In one of the studies, people receiving self-management felt more empowered to manage their condition. There was no information on the impact of self-management on symptoms of bronchiectasis, adverse events or potential cost savings arising from more effective self-management. There are no studies looking at self-management in children.
Overall there is not enough information to assess whether strategies to support self-management may help people with bronchiectasis and further studies are needed. Future studies will need to look at how often flare ups occur, how often antibiotics are prescribed, and how long for, whether people have a better quality of life, and the impact of self-management on costs of care. It is also important to look at self-management for bronchiectasis in children.
Quality of the results
This review is based on only two small trials and the quality of the studies is very poor. With only two studies looking at very specific approaches to self-management we cannot say with any degree of certainty whether self-management strategies work for people with bronchiectasis, but until further evidence is available we advocate adherence to current international guidelines that recommend self-management for people with bronchiectasis.