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Lumacaftor/ivacaftor (LUM/IVA) improves outcomes in cystic fibrosis (CF) patients homozygous for Phe508del with ppFEV140%. There is limited safety or efficacy data in patients with ppFEV140%. We determined whether LUM/IVA in patients with ppFEV140 would reduce the rate of pulmonary exacerbations.This was a case control study performed on patients12 years, homozygous for Phe508del CFTR mutation and with ppFEV140%. Control subjects were matched for age, sex and ppFEV1, and had mutations ineligible for LUM/IVA. We assessed the rate of pulmonary exacerbations requiring intravenous antibiotics, the mean rate of change in ppFEV1 over 12 months and all adverse events.Data was collected from 7 Australian CF centres on 105 patients; 72 on LUM/IVA and 33 controls. LUM/IVA demonstrated a large reduction in exacerbations with an incident rate ratio of 0.455 (95%CI; 0.306 - 0.676), p 0.001 after adjusting for the number of exacerbations in the previous 12 months. LUM/IVA prolonged the time to first exacerbation and reduced the rate of decline in ppFEV1 over 12 months. Adverse events were common; chest tightness or dyspnoea was experienced by 55% and resulted in cessation of treatment in 32%.Treatment with LUM/IVA resulted in a substantially lower rate of pulmonary exacerbations, prolonged time to first exacerbation and slowed the rate of decline of ppFEV1 in participants with severe lung disease. Adverse reactions to LUM/IVA however were unacceptably frequent, and resulted in a very high discontinuation rate.

Spirometry is usually performed under the supervision of a trained respiratory scientist to ensure acceptability and repeatability of results. To evaluate the quality of spirometry performance by adult cystic fibrosis (CF) patients with and without observation by a trained respiratory scientist, an observational, single centre study was conducted between February to December 2020. 74 adults were recruited and instructed to perform spirometry without supervision within 24 h of their remote CF clinic consultation. Spirometry was repeated at their consultation, supervised by a respiratory scientist using video conferencing. The majority of patients achieved grade A (excellent) or B (very good) spirometry quality with (95%) and without supervision (93%) independent of lung function severity. Similarly, forced expiratory volume in 1 second demonstrated no significant differences with paired spirometry performed within a 24 hour period. For a large proportion of adult CF patients, unsupervised portable spirometry produces acceptable and repeatable results.

Bronchiectasis is reported to be more frequent in females. There have been no large studies examining the impact of biological sex on disease characteristics, aetiology, severity, quality of life or management. Patients were prospectively enrolled from 2015 -2018 in 3 linked bronchiectasis registries in Australia, Europe and India. Disease information was collected, including quality of life (QoL-B). Analyses were conducted cross-sectionally using baseline data. 13859 patients were included from 29 countries. 57.6% were female. The highest proportion of females were in Australia (70.9%) and lowest in India (43.1%). Male sex was associated with bronchiectasis caused by COPD and TB; while female sex was associated with post-infectious bronchiectasis, asthma, connective tissue disease and NTM. Men had more severe disease as measured by the bronchiectasis severity index, but females more likely to be infected with Pseudomonas aeruginosa. Women had greater disease impact across multiple QoL-B domains including social, emotional and treatment burden domains. Cough and sputum purulence were more severe in women while men most frequently complained of wheeze and breathlessness. Men were significantly less likely to receive evidence based interventions including testing for immunodeficiency and ABPA, long term antibiotic treatment for frequent exacerbators, pulmonary rehabilitation and airway clearance techniques. Conclusion: There are striking sex differences in aetiology, severity, quality of life and treatment in patients with bronchiectasis

Once neglected in research and underappreciated in practice, there is renewed interest in bronchiectasis unrelated to cystic fibrosis. Bronchiectasis is a chronic lung disease characterised by chronic cough, sputum production and recurrent pulmonary exacerbations. It is diagnosed radiologically on high resolution computed tomography chest scan by bronchial dilatation (wider than the accompanying artery). The causes of bronchiectasis are diverse and include previous respiratory tract infections, chronic obstructive pulmonary disease, asthma, immunodeficiency and connective tissue diseases. A large proportion of cases are idiopathic, reflecting our incomplete understanding of disease pathogenesis. Progress in the evidence base is reflected in the 2017 European management guidelines and the 2015 update to the Australian guidelines. Effective airway clearance remains the cornerstone of bronchiectasis management. This should be personalised and reviewed regularly by a respiratory physiotherapist. There is now robust evidence for the long term use of oral macrolide antibiotics in selected patients to reduce exacerbation frequency. The routine use of long term inhaled corticosteroids and/or long-acting bronchodilators should be avoided, unless concomitant chronic obstructive pulmonary disease or asthma exists. The evidence for nebulised agents including hypertonic saline, mannitol and antibiotics is evolving; however, access is challenging outside tertiary clinics, and nebulising equipment is required. Smokers should be supported to quit. All patients should receive influenza and pneumococcal vaccination. Patients with impaired exercise capacity should attend pulmonary rehabilitation. There is an important minority of patients for whom aetiology-specific treatment exists. The prevalence of bronchiectasis is increasing worldwide; however, the burden of disease within Australia is not well defined. To this end, the Australian Bronchiectasis Registry began recruitment in 2016 and is interoperable with the European and United States bronchiectasis registries to enable collaborative research. The recent addition of a bronchiectasis diagnosis-related group to the Australian Refined Diagnostic Related Group classification system will allow definition of the disease burden within the Australian hospital system.

Australian data regarding the management of patients with bronchiectasis is scarce. We sought to compare the management of adults with bronchiectasis attending tertiary Australian centres with recent national and international guidelines. The Australian Bronchiectasis Registry is a centralised database of patients with radiologically confirmed bronchiectasis unrelated to cystic fibrosis recruited from 14 tertiary Australian hospitals. We excluded children (

Background /objective: There are no large, multi-centre studies of Australians with bronchiectasis. The Australian Bronchiectasis Registry (ABR) was established in 2015 to create a longitudinal research platform. We aimed to describe the baseline characteristics of adult ABR participants and assess the impact of disease severity and exacerbation phenotype on quality of life (QoL). Methods The ABR is a centralised database of patients with radiologically confirmed bronchiectasis unrelated to cystic fibrosis. We analysed the baseline data of adult patients (≥18 years). Results From March 2016–August 2018, 799 adults were enrolled from 14 Australian sites. Baseline data were available for 589 adults predominantly from six tertiary centres (420 female, median age 71 years (interquartile range 64–77), 14% with chronic Pseudomonas aeruginosa infection). Most patients had moderate or severe disease based on the Bronchiectasis Severity Index (BSI) (84%) and FACED (59%) composite scores. Using Global Lung function Initiative-2012 reference equations, the majority of patients (48%) had normal spirometry; only 34% had airflow obstruction (FEV1/FVC Conclusions The largest cohort of Australian adults with bronchiectasis has been described. Using contemporary criteria, most patients with bronchiectasis did not have airflow obstruction. The frequent exacerbation trait connotes poorer QoL and greater health-care utilisation.

Objectives: Cystic fibrosis-related diabetes (CFRD) impacts approximately 40 to 50% of adults with cystic fibrosis (CF). Effective diabetes education has been shown to improve long-term self-management and quality of life. This survey explores the educational needs of patients with or developing CFRD and sets out to identify the optimal mode of delivery for diabetes education. Methods: Adult pre- and post-transplant patients with CFRD and early glucose metabolism abnormalities from the Royal Prince Alfred Hospital CF Clinic were invited to partake in an online survey via email or text message in December 2020. The study protocol was approved by the Sydney Local Health District Ethics Committee (X20-0434). Results: 46 participants completed the survey with a response rate of 45% (female 54%;CFRD 78%;mean duration since CFRD diagnosis: 13 years;post-transplant 15%). Main sources of diabetes education for participants were the CF Clinic (65%);Google search (30%) and their general practitioner (13%). 72% of participants with CFRD felt they had enough information to manage their diabetes but favoured having a diabetes education resource package. The majority of participants preferred to receive CFRD information via an email package (61%), while others favoured perusing an educational website (37%) or phone app (24%), when requested (44%) or every 6 months (31%). The most common categories of diabetes-related information requested by participants with CFRD were updated diabetic technology (75%), CF diet and food diaries (58%), exercise (56%), management of hyper-(58%) or hypoglycemia (47%) and diabetes and alcohol consumption (42%). Conclusion: Patients with CFRD and early glucose metabolism abnormalities have ongoing educational needs and may require improved resources, preferably via virtual platforms, to supplement in-person care. Future research on the clinical impact of increasing virtual education will be necessary during this COVID-19 pandemic and beyond.