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touchMDT The patient pathway to diagnosis for non-cystic fibrosis bronchiectasis

MDT specialists and a patient with non-cystic fibrosis (non-CF) bronchiectasis discuss the pathophysiology, comorbidities and the pathway to diagnosis

 Overview & Learning Objectives

Patient with non-CF bronchiectasis
Primary care physician and pulmonologist
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The pathophysiology and comorbidities of non-CF bronchiectasis Prof. Barbara Yawn, Prof. James Chalmers

Watch a primary care physician and a pulmonologist share insights on the underlying pathophysiology of non-CF bronchiectasis and how to differentiate the condition from common respiratory comorbidities.

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Pulmonologist, primary care physician and patient
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Non-CF bronchiectasis clinical presentation Prof. James Chalmers, Prof. Barbara Yawn, Ms Marta Almagro

Watch a pulmonologist and a primary care physician review the clinical presentation of non-CF bronchiectasis, and hear from a person living with non-CF bronchiectasis on how the condition impacts her daily life.

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Primary care physician, pulmonologist, radiologist and patient
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Approaches to the diagnosis of non-CF bronchiectasis Prof. Barbara Yawn, Prof. James Chalmers, Prof. Mary Salvatore, Ms Marta Almagro

Watch a primary care physician, a pulmonologist and a radiologist discuss the tools used to diagnose non-CF bronchiectasis and highlight the importance of the MDT. Plus, a person living with non-CF bronchiectasis shares her diagnostic journey.

Watch Video
Primary care physician and pulmonologist

Watch a primary care physician and a pulmonologist share insights on the underlying pathophysiology of non-CF bronchiectasis and how to differentiate the condition from common respiratory comorbidities.

Expert Spotlight
Prof. Barbara Yawn
University of Minnesota, Minneapolis, MN, USA
Prof. James Chalmers
University of Dundee, Dundee, Scotland, UK

Prof. Barbara Yawn and Prof. James Chalmers discuss the pathophysiology and common comorbidities of non-CF bronchiectasis and share advice for primary care physicians on when to suspect non-CF bronchiectasis in clinical practice.

Listen on the Go

 Learn more Back to MDT Hub Time: 10:15
 
Pulmonologist, primary care physician and patient

Watch a pulmonologist and a primary care physician review the clinical presentation of non-CF bronchiectasis, and hear from a person living with non-CF bronchiectasis on how the condition impacts her daily life.
Expert Spotlight
Prof. James Chalmers
University of Dundee, Dundee, Scotland, UK
Prof. Barbara Yawn
University of Minnesota, Minneapolis, MN, USA
Ms Marta Almagro
Barcelona, Spain

Prof. James Chalmers, Prof. Barbara Yawn and Ms Marta Almagro discuss the key signs and symptoms of non-CF bronchiectasis, and Ms Marta Almagro shares her experience of living with non-CF bronchiectasis.

Listen on the Go

 Learn more Back to MDT Hub Time: 12:51
 
Primary care physician, pulmonologist, radiologist and patient

Watch a primary care physician, a pulmonologist and a radiologist discuss the tools used to diagnose non-CF bronchiectasis and highlight the importance of the MDT. Plus, a person living with non-CF bronchiectasis shares her diagnostic journey.
Expert Spotlight
Prof. Barbara Yawn
University of Minnesota, Minneapolis, MN, USA
Prof. James Chalmers
University of Dundee, Dundee, Scotland, UK
Prof. Mary Salvatore
Columbia University, New York, NY, USA
Ms Marta Almagro
Barcelona, Spain

Prof. Barbara Yawn, Prof. James Chalmers and Prof. Mary Salvatore are joined by Ms Marta Almagro, a person living with non-CF bronchiectasis. Together, they review the different tools used to diagnose patients with non-CF bronchiectasis and consider the importance of collaboration between members of the MDT.

Listen on the Go

 Learn more Back to MDT Hub Time: 12:27
 
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Overview & Learning Objectives
Overview

In this activity, a pulmonologist, a radiologist and a primary care physician involved in diagnosing and managing patients with non-CF bronchiectasis share their experiences of recognizing and diagnosing the condition, and discuss their role within the MDT. Plus, hear from a patient on her personal journey to diagnosis with non-CF bronchiectasis and its impact on her daily life.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of pulmonologists, radiologists and primary care physicians involved in the diagnosis and management of non-CF bronchiectasis.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Prof. James Chalmers discloses: Advisory board or panel fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Insmed, Janssen, Novartis, Pfizer and Zambon. Grants/research support from AstraZeneca, Boehringer Ingelheim, Gilead Sciences, GlaxoSmithKline, Grifols, Insmed and Novartis.

Prof. Mary Salvatore discloses: Advisory board or panel fees, grants/research support and speaker’s bureau fees from Boehringer Ingelheim and Genentech.

Prof. Barbara Yawn discloses: Advisory board or panel fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Mylan and Teva. Grants/research support from GlaxoSmithKline (relationship terminated).

Ms Marta Almagro has no interests/relationships or affiliations to disclose in relation to this activity.

Content reviewer

Angela Massey Hill, Pharm.D., CPh, RPh has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Directors

Katrina Lester and Sola Neunie have no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu.

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu)

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 25 October 2022. Date credits expire: 25 October 2024.

If you have any questions regarding credit please contact cpdsupport@usf.edu

Learning Objectives

After watching this activity, participants should be better able to:

  • Describe the pathophysiology and comorbidities of non-CF bronchiectasis
  • Appraise the clinical presentations of non-CF bronchiectasis
  • Analyse the methodologies to diagnose non-CF bronchiectasis
Faculty & Disclosures
Prof. James Chalmers

University of Dundee, Dundee, Scotland, UK

James Chalmers is a clinical professor and the Asthma and Lung UK chair of respiratory research at the University of Dundee. He is also an honorary consultant respiratory physician at Ninewells Hospital in Dundee, Scotland, UK. read more

Prof. Chalmers’ clinical and research interests are in challenging respiratory infections, particularly bronchiectasis, COPD and pneumonia. He is currently chair of the Science and Research Committee of the British Thoracic Society and deputy chief editor of the European Respiratory Journal. He chairs the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) European Bronchiectasis Registry and has previously chaired international guideline panels in bronchiectasis, COPD and COVID-19.

Prof. James Chalmers discloses: Advisory board or panel fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Insmed, Janssen, Novartis, Pfizer and Zambon. Grants/research support from AstraZeneca, Boehringer Ingelheim, Gilead Sciences, GlaxoSmithKline, Grifols, Insmed and Novartis.
Prof. Mary Salvatore

Columbia University, New York, NY, USA

Mary Salvatore is an associate professor of radiology at Columbia University Irving Medical Center in New York, NY, USA. read more

Prof. Salvatore specializes in thoracic radiology with a focus in interstitial lung diseases and patterns of fibrosis on CT images. She is actively involved in research, retrospectively reviewing well-established CT images of interstitial pneumonia, and looking at earlier examinations to determine the earliest CT manifestations of disease. Prof. Salvatore and colleagues created and now maintain a pulmonary fibrosis registry, which currently has over 400 patients enrolled. She is a passionate teacher, having lectured on the early and correct diagnosis of idiopathic pulmonary fibrosis, and she has written a text on CT interpretation for non-radiologists. Prof. Salvatore has also started a support group for patients with pulmonary fibrosis and their families. Her goal is to affect as many people as possible in a constructive way through education and a positive attitude.

Prof. Mary Salvatore discloses: Advisory board or panel fees, grants/research support and speaker’s bureau fees from Boehringer Ingelheim and Genentech.
Prof. Barbara Yawn

University of Minnesota, Minneapolis, MN, USA

Barbara Yawn is a professor of family medicine and community health at the University of Minnesota, Minneapolis, MN, USA. read more

Prof. Yawn’s work focuses on respiratory diseases and the development and assessment of tools for identifying common conditions in primary care practices. She has over 420 peer reviewed publications, authored three books and presented numerous educational programmes focused on primary care management of chronic illnesses in both the US and worldwide. Prof. Yawn has been a member of seven US national guideline panels and a member of the US Preventive Services Task Force. Her research has been funded by National Institutes of Health, Centers for Disease Control and Prevention, The Patient-Centered Outcomes Research Institutes and investigator-initiated grants from pharmaceutical companies.

Prof. Barbara Yawn discloses: Advisory board or panel fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Mylan and Teva. Grants/research support from GlaxoSmithKline (relationship terminated).
Ms Marta Almagro

Barcelona, Spain

Ms Marta Almagro is a person living with non-CF bronchiectasis and primary ciliary dyskinesia. read more

Since 2014, Ms Almagro has been a patient ambassador at the European Lung Foundation (ELF) and is also a patient advocate at the European Organisation for Rare Diseases (EURORDIS). She is also a member of the Bronchiectasis Patient Advisory Group of the joint ELF/EMBARC taskforce.

Ms Marta Almagro has no interests/relationships or affiliations to disclose in relation to this activity.
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This Activity Is Funded By:

An independent medical education grant from Insmed.
This activity is jointly provided by USF Health and touchIME.

The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

This content is intended for healthcare professionals.

Date of original release: 25 October 2022. Date credits expire: 25 October 2024.

This content is intended for healthcare professionals only. Please confirm that you are a healthcare professional.

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Question 1/5
Your patient with non-CF bronchiectasis has recurrent chest infections that induce a persistent cough and excessive purulent sputum production. How would you define the pathophysiological effects of their airway damage?

CF, cystic fibrosis.
Correct

Cole’s ‘vicious cycle’ is a widely accepted model describing the development of non-CF bronchiectasis.1 In this model, impaired mucociliary clearance leads to an accumulation of mucus that disrupts normal host defences, leaving the patient more vulnerable to infection.2 Persistent infection triggers an inflammatory response that causes abnormal airway remodelling and structural damage.2 Neutrophilic bronchial inflammation is characteristic of the disease.2

Abbreviation

CF, cystic fibrosis.

References

  1. Cole PJ. Eur J Respir Dis Suppl. 1986;147:6–15.
  2. Keir HR, Chalmers JD. Semin Respir Crit Care Med. 2021;42:499–512.
Question 2/5
Your 67-year-old female patient presents with breathlessness, rhinosinusitis and fatigue. Which of the following additional symptoms would lead you to suspect non-CF bronchiectasis?

CF, cystic fibrosis.
 Correct

The classic symptoms of non-CF bronchiectasis are a chronic cough, excessive purulent sputum and recurrent respiratory infections, which may be accompanied by pleuritic chest pain, haemoptysis, breathlessness and lethargy.1 In a cross-sectional study of 103 adults with newly diagnosed bronchiectasis, >95% reported a chronic productive cough, while daily sputum production occurred in >75% of patients.2

Abbreviation

CF, cystic fibrosis.

References

  1. MacFarlane L, et al. Clin Med (Lond). 2021;6:e571–7.
  2. King PT, et al. Respir Med. 2006;100:2183–9.
Question 3/5
You suspect that your patient with non-CF bronchiectasis is having an acute exacerbation characterized by an increase in coughing, sputum volume and dyspnoea. Which of the following would you consider as a potential biomarker of infection?

CF, cystic fibrosis.
 Correct

Assessing sputum colour using a chart may provide a consistent, simple and non-invasive method to assess and monitor disease severity and acute exacerbations in non-CF bronchiectasis. Clear or white sputum indicates a low number of inflammatory cells, while an increasing gradient of green indicates the accumulation of neutrophils, and thus infection. Myeloperoxidase, a green haem-containing protein released from neutrophil primary granules following phagocytosis, gives the sputum its distinctive green colour. Sputum colour, therefore, represents an easily interpreted biomarker of infection.

Abbreviation

CF, cystic fibrosis.

Reference

Chalmers JD, Finch S. Respirology. 2014;19:153–4.

Question 4/5
Your 52-year-old female patient has rheumatoid arthritis and has been receiving a combination of anti-rheumatic drugs for the last 4 years. Over the past year, you have seen her at your clinic on five separate occasions where she has presented with a persistent productive cough and dyspnoea. You suspect non-CF bronchiectasis. What would you do next to confirm a diagnosis?

CF, cystic fibrosis; HRCT, high-resolution computed tomography.
Correct

The gold-standard diagnostic test for non-CF bronchiectasis is a chest HRCT scan.1 A sweat test and/or genetic testing are routinely used to diagnose CF.2 A spirometry test offers a limited view of bronchiectasis and its complex pathophysiology, and is, therefore, not used to confirm a diagnosis of non-CF bronchiectasis.3

Abbreviations

CF, cystic fibrosis; HRCT, high-resolution computed tomography.

References

  1. Tiddens HAWM, et al. Eur Respir Rev. 2020;29:190120.
  2. Gokdemir Y, et al. Front Pediatr. 2021;9:649904.
  3. Radovanovic D, et al. Respir Med. 2018;145:120–9.
Question 5/5
Your 25-year-old patient has a history of severe pneumonia, and has been experiencing recurrent infections and a persistent cough for the last 6 months. You suspect non-CF bronchiectasis, which is confirmed by a radiologist following an HRCT scan. The radiologist has also evaluated the radiographic pattern of bronchiectasis to determine the aetiology. Their report reads: ‘A bronchus diameter greater than the diameter of the adjacent pulmonary artery, which is varicose and predominantly seen in the lower lung lobes.’ Based on this report, what is your aetiological diagnosis?

CF, cystic fibrosis; HRCT, high-resolution computed tomography.
Correct

Non-CF bronchiectasis can be diagnosed by HRCT when an abnormally wide and thickened airway, often showing a lack of tapering, is larger than the adjacent artery.1 Taking into account the history and age of the patient, the pattern of distribution and lobular predisposition can provide further insights to the underlying aetiology of bronchiectasis.2,3 For example, a lower-zone distribution may suggest chronic aspiration, primary ciliary dyskinesia, CVID, Mounier-Kuhn syndrome, and traction bronchiectasis due to idiopathic interstitial pneumonias and asbestosis.2,3

Abbreviations

CF, cystic fibrosis; CVID, combined variable immunodeficiency; HRCT, high-resolution computed tomography.

References

  1. Tiddens HAWM, et al. Eur Respir Rev. 2020;29:190120.
  2. Chan ED, et al. Respir Med. 2019;1:100006.
  3. Singh A, et al. Curr Probl Diagn Radiol. 2019;48:53–60.
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