Bronchiectasis in the Kimberley region of Western Australia

Objective To review the work‐up and inpatient management of non‐cystic fibrosis bronchiectasis exacerbations against best practice guidelines in the Kimberley, a remote region of Western Australia, with the ultimate goal of improving treatment in the region. ^Design Retrospective cohort study and audit of remote adult bronchiectasis hospital admissions between 2011 and 2016. Setting Remote hospital inpatients. Participants Thirty‐two patients and 110 hospital admissions were included. Patients were ≥15 years old, had computed tomography confirmed bronchiectasis and at least one hospital admission for acute respiratory illness prior to January 2011. Main outcomes measured The 5‐year mortality and compliance to a Lung Foundation position statement on non‐cystic fibrosis bronchiectasis which suggests investigating for an underlying cause at diagnosis and during exacerbations prolonged antibiotics (10–14 days) and prolonged hospital admissions (≥7 days) are required. Results The overall 5‐year mortality was 21.8%, with the median age at death of 37 years ( interquartile range , 27–63). The median duration of hospital admission was shorter than the recommended 3 days ( interquartile range , 2–5) with 11 of 100 (11%) patients admitted for ≥7 days. The median duration of antibiotics was also shorter than the recommended 7 days ( interquartile range , 4–10), with 31 of the 98 (32%) patients prescribed ≥10 days and 6 of the 98 (6%) prescribed ≥14 days of therapy. Conclusion We found under‐treatment and under‐investigation of non‐cystic fibrosis bronchiectasis in the Kimberley region. Five‐year mortality was high, consistent with other rural Australian Indigenous cohorts. § Following this audit, a strategy to improve awareness, as well as update and promote regional guidelines has been developed.