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Paediatric Pulmonology and Allergology
2005 April, Vol. VIII, No. 1 (2810-2827)
MANAGEMENT OF SUPPURATIVE LUNG DISEASE
Andrew Bush
Imperial School of Medicine at National Heart and Lung Institute and Royal Brompton Hospital, London, UK
The management of the non-CF child with bronchiectasis should be just as meticulous as in CF. A standardized diagnostic evaluation should be performed to exclude conditions for which there is specific treatment. Given the evidence of equal disability as in CF, the respiratory management of the two conditions should be equally meticulous. Unfortunately, most therapeutic recommendations have to be based on studies in CF; there is a great need for studies in children with non-CF bronchiectasis, to improve the evidence base for treatment of this condition). In our series of children with established, non-cystic fibrosis bronchiectasis, a specific cause which changed management could be found in more than half. Chest physiotherapy is the mainstay of mucus clearance in CF and other causes of chronic bronchial sepsis, and the bedrock of the respiratory management of these conditions. The role of prophylactic antibiotics in CF is unclear. RhDnase was the subject of the largest randomized controlled clinical trial ever performed in CF, which demonstrated improvement in lung function and reduction in infective exacerbations sustained over six months in patients with moderately severe CF.