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Interview with Professor Adam Hill: 2022 BTS Bronchiectasis Quality Standards

Monday, November 7, 2022

What is Bronchiectasis and who does it affect in the UK?

Bronchiectasis is a chronic respiratory disease characterised by recurrent cough, sputum production and respiratory tract infections. Patients have permanently damaged and dilated airways. Bronchiectasis is diagnosed using a CT scan of the chest showing dilated airways compared with the accompanying vessel. Bronchiectasis is common and affects around 5 per 1,000 of the population.

The commonest risk factor for the development of bronchiectasis appears to be the result of a past infection such as a pneumonia (an infection in the lung) but in many we don’t always identify a route cause.

Many patients with bronchiectasis will often have other health conditions, in particular asthma and COPD are often found in our patients with bronchiectasis

Why is it important to develop a Quality Standard on Bronchiectasis?

It is known from national and international audits that management of bronchiectasis is variable throughout the UK and internationally. The updated BTS guidelines in 2019 represent evidence based, or if evidence is not available, advice on management of bronchiectasis from experts in the field.

The Quality standards provide a benchmark for auditing and improving bronchiectasis clinical practice. BTS Quality Standards are useful for: patients with bronchiectasis and their carers to enable understanding of what services they should expect from their health and social care provider; for healthcare professionals to allow decisions to be made about care based on the latest evidence and best practice; for service providers to be able to audit the clinical performance of their organisation and assess the standards of care they provide; for commissioners so that they can be confident that the services they are purchasing are high quality and cost-effective.

Who was involved in developing the Quality Standard and did you face any particular challenges along the way?

The chairs of the 2019 BTS guideline (Adam Hill, Anita Sullivan, and Michael Loebinger), Physiotherapy input (Lizzie Grillo), Specialist nursing input (Karen Payne), General Practice input (Kevin Gruffydd-Jones), Patient input (James Wildgoose) and BTS input (Miguel Souto and Sally Welham). 

From a personal perspective the development of Quality Standards was an excellent team effort, and it was great working with excellent colleagues all committed to improving the management of bronchiectasis. The major challenge we all had was cutting down from 11 quality standards from the 2010 BTS Guideline to 6 quality standards, as we all felt that the original 11 were key. Cutting down to 6 key quality standards, however, focussed the mind to determine what is critical to improve the patient care for bronchiectasis. There was also excellent feedback from the Standards of Care Committee and the external consultation, and I am sure you will agree this has led to an excellent final version.

Who was the Self-Management Plan designed for and what benefits does it provide?

The self-management plan was designed for use for patients, Primary Care, and Secondary care. It facilitates three-way discussion between patients, primary and secondary care, which will help standardise and personalize treatment for their patients with bronchiectasis.

It will also allow more patient autonomy in management of their condition. This will allow earlier treatment of chest infections which aims to improve earlier recovery.

The self-management plan provided is a template that local services can adapt for their own service.

What are the main take-home messages from the Quality Standard?

There were six quality standards.

  • “People with bronchiectasis should be investigated for treatable causes of bronchiectasis” was to ensure that treatable causes are investigated as different therapies may be available and may improve the patient’s outcome.
  • “People with bronchiectasis should be offered a review by a specialist respiratory physiotherapist or qualified healthcare professional” to recommend chest clearance techniques, give advice on airways adjuncts and pulmonary rehabilitation.
  • “People with bronchiectasis should have an individualised written self-management plan” to improve patients’ autonomy and three-way discussion between the patient, primary and secondary care.
  • “Patients with bronchiectasis and three or more exacerbations per year should be considered for long-term antibiotic treatment” as these can reduce the number of infections and improve the health-related quality of life in bronchiectasis patients.
  • “Services for people with bronchiectasis should include provision of home nebulised prophylactic antibiotics and home intravenous antibiotic therapy for suitable patients, supervised by a respiratory specialist” as these both facilitate out-patient treatment and reduce the need to come into hospital for treatment.
  • “All patients with bronchiectasis should receive at least an annual review of their condition when clinically stable” to ensure that management is optimised at least on an annual basis.

These are the key priorities and we hope that where services meet these standards, there is real a opportunity to improve the care of patients with bronchiectasis.


The new 2022 Bronchiectasis Quality Standards, including the self-management plan, are available here.