Improving the management of people with bronchiectasis in Saudi: A new beginning

D AL‐Jahdali and team are congratulated on producing the first published nonWestern country‐based management guidelines[1] for bronchiectasis. The burden of bronchiectasis is poorly quantified in most countries, but invariably, the burden (prevalence and severity) would be more severe in developing countries compared to developed countries. Yet, until the availability of the Saudi Thoracic Society (STS) guidelines,[1] the few available published guidelines on bronchiectasis have been from developed Western countries,[2,3] with the first being available only in 2002,[4] written as a position statement. Country and/or population specific guidelines are important for best practice clinical care for several reasons. As summarized by Woolf et al., “weighing the magnitude of the difference between the benefits and downsides to develop a recommendation also requires the knowledge of the likely absolute effects for a specific population or situation.”[5] Specifically for bronchiectasis, there are several reasons that include; first, the relative prevalence of underlying etiologies differs among various settings and countries. Thus, routine testing appropriate in some settings may be inappropriate in others. Examples include bronchiectasis related to tuberculosis infection or HIV is highly prevalent in some countries but rare in others. Second, the major differences of health systems among countries require country‐specific recommendations. People with bronchiectasis are under the medical care by primary health practitioners in some countries but under specialists in others. Third, population‐specific guidelines are more likely to have specific recommendations. The importance of this relates to the fact that clinical practice guideline formats influence practice whereby specific guidelines are significantly more effective than non‐specific ones.[6] Thus, this first national Saudi bronchiectasis guideline[1] produced by STS is a commendable start in a setting where the true prevalence of bronchiectasis is likely higher than in developed Western countries.