Variation in treatment preferences of pulmonary exacerbations among Australian and New Zealand cystic fibrosis physicians.

Autor:	Currie G; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia., Tai A; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.; Institute for Respiratory Health, Nedlands, Western Australia, Australia.; School of Medicine, The University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia., Snelling T; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia.; Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.; School of Public Health, Curtin University, Perth, Western Australia, Australia.; Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia., Schultz A; School of Medicine, The University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia andre.schultz@health.wa.gov.au.; Department of Respiratory Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia.; Respiratory Health, Telethon Kids Institute, Nedlands, Western Australia, Australia.
Jazyk:	angličtina
Zdroj:	BMJ open respiratory research [BMJ Open Respir Res] 2021 Jul; Vol. 8 (1).
DOI:	10.1136/bmjresp-2021-000956
Abstrakt:	Background: Despite advances in cystic fibrosis (CF) management and survival, the optimal treatment of pulmonary exacerbations remains unclear. Understanding the variability in treatment approaches among physicians might help prioritise clinical uncertainties to address through clinical trials. Methods: Physicians from Australia and New Zealand who care for people with CF were invited to participate in a web survey of treatment preferences for CF pulmonary exacerbations. Six typical clinical scenarios were presented; three to paediatric and another three to adult physicians. For each scenario, physicians were asked to choose treatment options and provide reasons for their choices. Results: Forty-nine CF physicians (31 paediatric and 18 adult medicine) participated; more than half reported 10+ years of experience. There was considerable variation in primary antibiotic selection; none was preferred by more than half of respondents in any scenario. For secondary antibiotic therapy, respondents consistently preferred intravenous tobramycin and a third antibiotic was rarely prescribed, except in one scenario describing an adult patient. Hypertonic saline nebulisation and twice daily chest physiotherapy was preferred in most scenarios while dornase alfa use was more variable. Most CF physicians (>80%) preferred to change therapy if there was no early response. Professional opinion was the most common reason for antibiotic choice. Conclusions: Variation exists among CF physicians in their preferred choice of primary antibiotic and use of dornase alfa. These preferences are driven by professional opinion, possibly reflecting a lack of evidence to base policy recommendations. Evidence from high-quality clinical trials is needed to inform physician decision making. Competing Interests: Competing interests: AS received honorarium funds from Vertex Pharmaceuticals for being on an advisory panel. GEC, AT and TS have no conflicts of interest to declare. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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