Bronchiectasis: encouraging telehealth results, but small sample sizes

Different interventions under one label

The researchers searched five databases to examine the feasibility and clinical effectiveness of telehealth in adults with bronchiectasis. The studies covered pulmonary rehabilitation, physical activity promotion, airway clearance techniques and multidisciplinary care.

This diversity matters: providing remote rehabilitation and supporting airway clearance are not the same intervention. A favourable result for one therefore does not demonstrate the effectiveness of all care delivered via telehealth.

Good adherence, possible quality-of-life benefits

The studies reported adherence to interventions ranging from 73 to 100%, and patient satisfaction from 81 to 100%. These findings support feasibility among the participants studied, but do not establish a clinical benefit on their own.

For pulmonary rehabilitation, four studies involving just 21 participants reported improvements in quality of life at the end of the intervention. Effect sizes ranged from small to large depending on the domains of the questionnaire used. Results for psychological symptoms, however, were mixed.

For remote airway clearance, the review reports an improvement in the total St George’s Respiratory Questionnaire score: a mean difference of −5.8 points, with a 95% confidence interval ranging from −10.8 to −0.9. However, the abstract does not specify the comparator associated with this estimate.

Not yet proof of equivalence to in-person care

The abstract consulted does not detail the comparators, the duration of the interventions or whether benefits persisted after they ended. It therefore does not allow the conclusion that telehealth can replace in-person care or provide lasting benefits.

Minor adverse events are reported for some interventions. With such small sample sizes and no detailed description in the abstract, safety remains insufficiently characterised. The authors call for larger trials.

What we can take away

Telehealth appears feasible for some aspects of bronchiectasis care and could improve quality of life. This review is not enough to establish its equivalence to in-person care.