Pediatric Bronchiectasis Action Management Plan to Improve Clinical Outcomes: A Randomized Controlled Trial

Area of Science:

• Pediatric Pulmonology
• Respiratory Medicine
• Clinical Trials

Background:

• Managing pediatric bronchiectasis exacerbations is crucial, yet evidence-based strategies are limited.
• Chronic suppurative lung disease (CSLD)/bronchiectasis affects children, necessitating effective management plans.
• Limited data exist on structured management plans for pediatric bronchiectasis.

Purpose of the Study:

• To evaluate if a personalized Bronchiectasis Action Management Plan (BAMP) reduces nonscheduled physician visits in children with CSLD/bronchiectasis compared to standard care.
• To assess the impact of BAMP on acute exacerbations, quality of life, and influenza vaccination rates.
• To determine the efficacy of a structured, personalized management plan in pediatric respiratory care.

Main Methods:

• A multicenter, randomized controlled trial involving children (<19 years) with CSLD/bronchiectasis.
• Participants were randomized to receive a personalized BAMP or standard care.
• Primary outcome: annual rate of nonscheduled physician visits for respiratory exacerbations; secondary outcomes: exacerbation rates, quality of life, and influenza vaccination.

Main Results:

• No significant difference in nonscheduled physician visits between BAMP and control groups (IRR, 0.98).
• Sensitivity analysis of pre-COVID-19 data showed a trend towards reduced visits with BAMP (IRR, 0.63).
• BAMP group showed significantly higher timely influenza vaccination rates (OR, 2.03).

Conclusions:

• Bronchiectasis Action Management Plans (BAMPs) improve influenza vaccination uptake in pediatric patients with CSLD/bronchiectasis.
• While not statistically significant in the overall trial, pre-pandemic data suggest BAMPs may reduce unscheduled physician visits.
• The COVID-19 pandemic likely influenced overall results; BAMPs are perceived as useful and practical by users.