25.4% of patients with bronchiectasis had symptoms for more than 10 years before diagnosis

Key takeaways:

• This study cohort was made up of 71.3% U.K. patients with bronchiectasis.
• Referral to pulmonary rehabilitation was presented to 19.6% of patients.

Prior to being diagnosed with bronchiectasis, many patients reported living with symptoms for multiple years, according to results published in European Respiratory Journal.

“Our results indicate that receiving a diagnosis of bronchiectasis typically takes years, often more than a decade, after symptom onset, which suggests diagnostic delays,” Arietta Spinou, MSc, PhD, lecturer in cardiorespiratory physiotherapy practice and research at King’s College London, and colleagues wrote.

Through a 67-item online survey made by the European Multicentre Bronchiectasis Audit and Research Collaboration and the European Lung Foundation, Spinou and colleagues analyzed responses from 760 patients with bronchiectasis to gain insight into their diagnosis and care experiences.

Within the total cohort, 71.3% of patients lived in the U.K., with fewer patients living in Germany (6.4%), the U.S. (3.3%) and Canada (2.8%).

The longest span of time with symptoms before receiving a diagnosis of bronchiectasis on the survey was more than 10 years, and this was the category with the highest proportion of patients at 25.4%. The second highest proportion of patients lived with symptoms for 2 to 5 years before diagnosis (21.8%), followed by those who lived with symptoms for 5 to 10 years (15%).

More patients who reported living with symptoms for more than 10 years before diagnosis vs. fewer years before diagnosis had bacterial infections (43% vs. 33%; P = .015).

In contrast, hospitalizations, lung function and patient-derived severity scores did not differ between these two groups, according to researchers.

When asked about a misdiagnosis, 25.7% of patients reported this occurrence.

High proportions of patients reported receiving care from a general practitioner/doctor (23.6%), a bronchiectasis center hospital (20.8%) or a respiratory — not bronchiectasis — specialist (19.5%).

In terms of testing, less than half (42.5%) reported undergoing a blood test for the immune system. The proportions of patients who reported being tested for cystic fibrosis (20.1%) and primary ciliary dyskinesia (9.9%) were even smaller.

Additionally, sending sputum cultures for analysis occurred more frequently during an exacerbation than when the patient was clinically stable based on survey responses (45.8% vs. 33.9%).

On the same note, 35.4% of patients with bronchiectasis had difficulties getting a sputum culture at the beginning of an infection. Result delays were also noted by 29.6% of patients, according to researchers.

Despite 82.4% of patients reporting a cough productive of sputum, a smaller proportion received referral to a specialist for instructions on airway clearance (61.7%).

Accessing “a primary care physician with a good understanding of chest infections” when experiencing an exacerbation was a difficult task for 50.2% of patients.

Lastly, referral to pulmonary rehabilitation (PR) was presented to 19.6% of patients, and researchers found a significant link between PR attendance and three patient factors: higher modified Medical Research Council dyspnea score (P < .001), older age (P < .001) and higher disease severity (P = .01).

“Our results highlight a need for improving education of primary care providers regarding bronchiectasis management, and improving accessibility to airway clearance management and PR,” Spinou and colleagues wrote.