A Cochrane review included 1 randomised crossover study with a total of 80 subjects. There was no statistical difference in lung function and exercise capacity parameters nor in the health related quality of life between the groups. The number of patient-reported infective exacerbations was 262 in 79.4 patient-years of follow up during nurse practitioner-led care, compared with 238 in 77.8 years during doctor led care (relative rate of exacerbations 1.09, 95% CI 0.91 to 1.30, p=0.34). There was a statistically higher proportion of hospital admissions in nurse-led care (66 vs. 42 admissions in doctor-led care; relative rate 1.52, 95% CI 1.03 to 2.23, p=0.03). Of these, there were 23 and 43 readmissions respectively attributable to bronchiectasis (relative rate 1.59, 95% CI 0.75 to 3.39, p=0.22). Nurse-led care resulted in significantly higher costs per patient; this was largely due to the difference in the number of hospital admissions and intravenous and nebulised antibiotic costs.
Comment: The quality of evidence is downgraded by limitations in study quality and by imprecise results (few patients).