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Diagnosis of bronchiectasis should be considered in individuals presenting with respiratory symptoms similar to asthma and chronic obstructive pulmonary disease that have not responded to usual treatment. This article provides an overview of the prevalence, diagnosis and management of bronchiectasis to inform nursing care and improve patient outcomes.

Background: Urinary incontinence has a negative impact on quality of life and often remains untreated due to low levels of self-reporting. Urinary incontinence is seen in cystic fibrosis associated bronchiectasis but little data are available for non-cystic fibrosis associated bronchiectasis., Method: In 2007 a new non-cystic fibrosis bronchiectasis service for patients aged 18 years and over was started within the Newcastle upon Tyne Hospitals NHS Foundation Trust. During the establishment of a new adult bronchiectasis service, patients were specifically asked about symptoms of incontinence, and if incontinence was identified then patients were referred for specialist continence assessment and management, in line with current good practice guidelines. The study relates only to those female patients who were referred to the continence service., Results: In this audit 116 patients attended the bronchiectasis service from 2009-2010; 76 were female, of these 55% had urinary incontinence, describing dramatic effects on quality of life. Prior to intervention the duration of symptoms of urinary incontinence for more than 5 years was 87.5%, with 40% of patients describing symptoms of more than 10 years duration without seeking medical attention. Following intervention from the nurse consultant for continence care, 80% of patients who were referred were discharged with an improvement in symptoms of urinary incontinence., Conclusion: This audit highlights the importance of specifically asking about urinary incontinence when assessing patients with adult bronchiectasis.

Despite intervention, some patients with bronchiectasis struggle to clear secretions. An advanced practitioner in respiratory medicine at Salford Royal Foundation Trust identified nebulised hypertonic saline (HTS) as a treatment that could potentially improve service provision. She developed and evaluated a safe drug challenge and monitoring service for nebulised HTS.

In a previous article on bronchiectasis, Alan Peres defined bronchiectasis, its pathophysiology and clinical manifestations, and how nurses may assess patients presenting with it (Peres, 2008). This article provides an overview of treatment and the role of the nurse in providing and managing the care of patients with this condition.

Alan Peres describes the epidemiology and pathophysiology of bronchiectasis, its most common clinical manifestations and the nursing assessment of patients who have it.

Background: Nurses have expanded and developed their roles to meet the needs of patients. This review evaluates the safety, effectiveness and health outcomes of nurses practising in autonomous roles, using advanced practice skills, within the context of a dedicated bronchiectasis clinic., Objectives: To determine the effectiveness of nurse-led care in the management of bronchiectasis., Search Strategy: The Cochrane Airways Group specialised register was searched on 12/06/02., Selection Criteria: Randomised controlled trials were eligible for inclusion in the review., Data Collection and Analysis: Two reviewers extracted and entered data from included studies., Main Results: One study was included in the review. No statistically significant changes were observed in infective exacerbations, lung function, exercise capacity, quality of life and hospital admissions. More healthcare resources were utilised by nurse-treated participants during the first arm of the study., Reviewer's Conclusions: This review has found one trial that does not demonstrate significant differences in clinical outcomes between nurse led care and doctor led care within the setting of a specialist clinic is, but there may be increased cost implications. Further research is required to review whether nurse led care provides the same outcomes in the community or secondary care setting.

Background: With the decrease in junior doctor hours, the advent of specialist registrars, and the availability of highly trained and experienced nursing personnel, the service needs of patients with chronic respiratory diseases attending routine outpatient clinics may be better provided by appropriately trained nurse practitioners., Methods: A randomised controlled crossover trial was used to compare nurse practitioner led care with doctor led care in a bronchiectasis outpatient clinic. Eighty patients were recruited and randomised to receive 1 year of nurse led care and 1 year of doctor led care in random order. Patients were followed up for 2 years to ensure patient safety and acceptability and to assess differences in lung function. Outcome measures were forced expiratory volume in 1 second (FEV(1)), 12 minute walk test, health related quality of life, and resource use., Results: The mean difference in FEV(1) was 0.2% predicted (95% confidence interval -1.6 to 2.0%, p=0.83). There were no significant differences in the other clinical or health related quality of life measures. Nurse led care resulted in significantly increased resource use compared with doctor led care (mean difference pound 1497, 95% confidence interval pound 688 to pound 2674, p<0.001), a large part of which resulted from the number and duration of hospital admissions. The mean difference in resource use was greater in the first year ( pound 2625) than in the second year ( pound 411)., Conclusions: Nurse practitioner led care for stable patients within a chronic chest clinic is safe and is as effective as doctor led care, but may use more resources.

Home intravenous therapy is the fastest growing area of health care in the USA and the Netherlands. This article examines the introduction of this form of treatment for a specific client group by the respiratory unit at the Glenfield Hospital.