Acceptability of a bronchiectasis clinic

All participants will receive care from the interdisciplinary bronchiectasis outpatient clinic. Participants will attend an initial assessment which is 60 minutes in duration and a review appointment at three months which is 45 minutes long. The overall duration of the intervention is three months. Additional appointments will be scheduled if clinically indicated after interdisciplinary team decision making (patients with recurrent infection and/or hospital admission or requiring additional education in self-management techniques). Patients will receive a follow up telephone call two weeks after the initial assessment from the physiotherapist to answer any questions from the bronchiectasis action plan developed. Patients will also be encouraged to contact the work telephone number of the physiotherapist if they have further questions prior to the scheduled three month review appointment. The targeted evidence-based interventions of the clinic will depend on patient need and will include any of the following: a medication action plan, an airway clearance plan, referral to pulmonary rehabilitation or home exercise prescription, physical activity (PA) and sedentary behaviour (SB) advice according to the Australian PA guidelines, and education relating to smoking cessation, avoidance of environmental airborne pollutants, hydration, the management of co morbidities such as sinusitis, and musculoskeletal pain and strategies for breathlessness and infection control. The medication action plan will be commenced by the respiratory physician prior to referral to the clinic, and then completed by the respiratory nurse practitioner at the clinic, along with education on medication timing and technique. The airway clearance therapy plan will be developed by a physiotherapist with expertise in respiratory disease and will involve the use of a range of possible techniques including the active cycle of breathing technique (ACBT), positive expiratory pressure (PEP) devices, patient positioning, forced expiratory technique (FET), percussion/vibrations and inhalation therapies. Education on hydration will involve targeting the colour of urine to achieve optimal hydration of secretions to improve airway clearance. Sinusitis management will assess the need for sinus wash out and/or ongoing medications to minimize the effect of sinus discharge into the respiratory tract. Musculoskeletal pain will be evaluated for its role in affecting cough and airway clearance therapy effectiveness. Pain profiles will influence the components/techniques used in the airway clearance therapy plan, with strategies to minimize pain prescribed. If breathlessness at rest or during activity is a feature of the presentation, specific advice on activity pacing, positioning, relaxed breathing techniques and fan therapy will be tailored to the individual. All patients will be given infection control advice relating to general respiratory hygiene and the cleaning of any airway clearance equipment or nebulisers used to minimize the potential for recurrent infection.