《2010TSANZ在澳大利亚和新西兰的儿童和成人的慢性化脓性肺部疾病和支气管扩张症指南》内容预览

Consensus recommendations for managing chronic suppurativelung disease (CSLD) and bronchiectasis, based on systematicreviews, were developed for Australian and New Zealand childrenand **s during a multidisciplinary workshop.
The diagnosis of bronchiectasis requires a high-resolutioncomputed tomography scan of the chest. People with symptoms ofbronchiectasis, but non-diagnostic scans, have CSLD, which mayprogress to radiological bronchiectasis.
 CSLD/bronchiectasis is suspected when chronic wet cough persistsbeyond 8 weeks. Initial assessment requires specialist expertise.Specialist referral is also required for children who have either twoor more episodes of chronic (> 4 weeks) wet cough per year thatrespond to antibiotics, or chest radiographic abnormalitiespersisting for at least 6 weeks after appropriate therapy.
Intensive treatment seeks to improve symptom control, reducefrequency of acute pulmonary exacerbations, preserve lungfunction, and maintain a good quality of life.
Antibiotic selection for acute infective episodes is based on resultsof lower airway culture, local antibiotic susceptibility patterns,clinical severity and patient tolerance. Patients whose conditiondoes not respond promptly or adequately to oral antibiotics arehospitalised for more intensive treatments, including intravenousantibiotics.
Ongoing treatment requires regular and coordinated primaryhealth care and specialist review, including monitoring forcomplications and comorbidities.
 Chest physiotherapy and regular exercise should be encouraged,nutrition optimised, environmental pollutants (including tobaccosmoke) avoided, and vaccines administered according to nationalimmunisation schedules.
Individualised long-term use of oral or nebulised antibiotics,corticosteroids, bronchodilators and mucoactive agents may

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