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Recommendations for travelling with bronchiectasis: a joint ELF/EMBARC/ERN-Lung collaboration

Michal Shteinberg, Barbara Crossley, Tal Lavie, Sima Nadler, Jeanette Boyd, Felix C. Ringshausen, Tim Aksamit, James D. Chalmers, Pieter Goeminne
ERJ Open Research 2019 5: 00113-2019; DOI: 10.1183/23120541.00113-2019
Michal Shteinberg
1Pulmonology Institute and CF Center – Carmel Medical Center, the Technion – Israel Institute of Technology, Haifa, Israel
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  • ORCID record for Michal Shteinberg
  • For correspondence: michalsh@technion.ac.il
Barbara Crossley
2European Lung Foundation Bronchiectasis Patient Advisory Group
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Tal Lavie
3Clinical Pharmacology Unit, Carmel Medical Center, Haifa, Israel
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Sima Nadler
2European Lung Foundation Bronchiectasis Patient Advisory Group
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Jeanette Boyd
4European Lung Foundation, Sheffield, UK
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Felix C. Ringshausen
5Dept of Respiratory Medicine, Hannover Medical School, Member of the German Centre for Lung Research, Hannover, Germany
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Tim Aksamit
6Mayo Clinic, Rochester, MN, USA
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James D. Chalmers
7Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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Pieter Goeminne
8Dept of Respiratory Medicine, AZ Nikolaas, Sint-Niklaas, Belgium
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  • Article
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Tables

  • TABLE 1

    Statements included in the questionnaire for experts and percentage agreement

    StatementAgreeDisagree
    Is it safe for all people with bronchiectasis to travel?
    •   Most people with bronchiectasis can safely travel for vacation or business

    96%4%
    •   It is best to avoid travelling during periods of unstable disease, such as during exacerbations

    92%8%
    •   People with bronchiectasis should consult their healthcare providers and plan for travel

    85%15%
    •   People with very severe bronchiectasis (e.g. candidate for lung transplantation, frequent hospitalisation) should be  advised not to travel abroad

    73%27%
    Planning travel: are there destinations and conditions that certain people with bronchiectasis should avoid?
    •   People with bronchiectasis should try to avoid travelling to places with high levels of air pollution

    73%27%
    •   People with bronchiectasis should try to avoid travelling to places with a high prevalence of NTM (e.g. Hawaii, USA)

    38%62%
    •   People with bronchiectasis should try to avoid travelling during influenza season

    35%65%
    •   People with bronchiectasis should consult their healthcare professional regarding staying at high altitudes

    85%15%
    •   Travelling to high-altitude destinations (above 3050 m/10 000 ft) should be avoided in people with bronchiectasis#

    32%68%
    •   People with bronchiectasis should preferably travel to destinations with a nearby bronchiectasis centre

    31%69%
    What travel insurance should people with bronchiectasis acquire?
    •   Health insurance with coverage of deterioration of a chronic condition

    100%
    •   Health insurance with coverage of hospital admission and emergency room visits#

    100%
    •   Health insurance with coverage of repatriation#

    68%32%
    What medications and devices should people with bronchiectasis carry with them when travelling?
    •   When travelling, it is recommended that people with bronchiectasis should continue taking their regular  treatments and make arrangements to take enough medications and equipment for the duration of their travel

    100%
    •   When travelling, people with bronchiectasis should consult their healthcare professional or respiratory  physiotherapist regarding possible alternatives to heavy or large equipment (e.g. nebulisers)

    100%
    •   People with bronchiectasis who suffer frequent pulmonary exacerbations should consult their specialist regarding  carrying antibiotics to be used in case of a pulmonary exacerbation when travelling

    100%
    •   Medications taken for travel should be properly stored according to manufacturer's recommendations (particularly  storage temperature, light exposure)

    100%
    •   Electricity requirements (e.g. for a nebuliser) and cleaning instructions should be known prior to travelling and  proper adaptations, including checking batteries, should be planned

    100%
    How can people with bronchiectasis maintain regular treatments when in transport?
    •   It is advised that airway clearance and inhalations are performed while waiting at airports before and after flights.  This is best planned ahead and checked with the airport for the best place to do this

    77%23%
    •   While it is not advised to take cough suppressants for bronchiectasis, it may be considered for long flights where  a cough may be disturbing to other passengers

    35%65%
    Do people with bronchiectasis need to prepare and carry certain documents?
    •   It is advised that patients with bronchiectasis carry documentation from the last clinic/hospitalisation visit,  translated into English and preferably also into the language of the country of destination

    81%19%
    •   A document for travel may be prepared and should include: patient's health status, allergies, chronic bacterial  infections, regular medications and devices used regularly, recommended medications during exacerbation

    100%
    •   It is advised that patients with bronchiectasis carry a translation of a disability card# (such as a European Union  disability parking card) if eligible and where available

    84%16%
    •   When travelling in a guided tour, it is advised that people with bronchiectasis should notify the travel company of  their condition

    69%31%
    What are oxygen requirements on the flight and at the travel destination?
    •   Oxygen requirements during commercial flights should be predicted before flight

    100%
    •   In people with an FEV1 <55% pred or oxygen saturation <93% at ambient air, a hypoxia inhalation test should be  performed

    77%23%
    •   In people with FEV1 <1.5 L, a hypoxia inhalation test should be performed#

    44%56%
    •   When planning travel to destinations between 2000 and 3050 m, considerations as for commercial flights should  be made

    92%8%
    How else can people with bronchiectasis be prepared to travel?
    •   It is recommended that people with bronchiectasis seek advice for travellers and follow recommended  immunisations for the destination

    100%
    •   Recommended medications while travelling (such as for the prevention of malaria) should be checked for  interactions with regular treatments and with treatments during exacerbations

    100%
    •   It is recommended that people with bronchiectasis should be stable prior to travelling, if symptoms typical for an  exacerbation develop shortly before travelling, treatment should be started and travel postponed if possible

    96%4%
    •   People with severe bronchiectasis and chronic Pseudomonas sp. infection may be advised to receive treatment  with an intravenous antibiotic course shortly before travelling to prevent an exacerbation while away

    50%50%
    What kind of activities may people with bronchiectasis engage in while on holiday and what precautions are recommended?
    •   It is recommended that people with bronchiectasis should use sun protection while using medications that  increase photosensitivity (e.g. ciprofloxacin, doxycycline)

    100%
    •   It is recommended that people with bronchiectasis take measures to avoid dehydration while in a hot climate

    100%
    •   It is advised that people with bronchiectasis maintain general measures of hygiene to prevent cross-infection:  hand hygiene, wearing face masks in crowded places

    88%12%
    •   It is recommended that all people with bronchiectasis refrain from SCUBA diving

    35%65%
    •   It may be safe for people with bronchiectasis to SCUBA dive if they are asymptomatic (no sputum or shortness of  breath at the time of diving) and lung function is normal (FEV1 and peak expiratory flow should both be  >80% pred, FEV1/forced vital capacity >75%)

    85%15%
    •   It is recommended that people with bronchiectasis should be aware of their own limitations to strenuous activities  and limit their participation in such activities accordingly. This refers to sports including hiking, swimming and  snorkelling, but also less strenuous activities such as short walks uphill and climbing stairs

    96%4%
    Where should people with bronchiectasis get help if they get sick while away?
    •   Prior to travel, people with bronchiectasis should be advised on increasing airway clearance if suffering an  exacerbation while away

    96%4%
    •   Prior to travel, people with bronchiectasis should be advised when to take antibiotics, including a recommendation  for an oral antibiotic, dose and duration

    100%
    •   People with bronchiectasis should be advised when and where to seek medical care at their destination

    88%12%

    NTM: nontuberculous mycobacteria; FEV1: forced expiratory volume in 1 s; SCUBA: self-contained underwater breathing apparatus; % pred: % predicted. #: 25 out of 26 responded; all other items had 26 responses.

    • TABLE 2

      Examples of equations for predicting hypoxaemia

      PaO2 Alt=0.410×PaO2Ground+17.652
      PaO2 Alt=0.519×PaO2Ground+11.855×(FEV1 L)−1.760
      PaO2 Alt=0.453×PaO2Ground+0.386×(FEV1 % pred)+2.44
      PaO2 Alt=22.8−(2.74×altitude in 1000s of feet)+0.68×PaO2Ground

      PaO2 Alt: predicted arterial oxygen tension at altitude (in millimetres of mercury); PaO2Ground: measured arterial oxygen tension at sea level (in millimetres of mercury); FEV1: forced expiratory volume in 1 s; % pred: % predicted. Information from [10].

      • TABLE 3

        Storage conditions for common medications for bronchiectasis

        Drug nameCommon trade names in EuropeStorage conditionsComments
        Oral antibiotics and antifungals
          AzithromycinCap. azithromycin 250 mg
        Cap. Azenil 250 mg
        Cap. azithromycin Inovamed 250 mg
        Cap. Zithromax 250 mg
        Tab. Zeto 250 mg
        Tab. azithromycin 250 mg
        Cap., tab.: store in the original package in order to protect from light; store below 25°CSkin photosensitivity: uncommon (≤1%)
        Alcohol: no special recommendation
        Azenil 200 mg/5 mL powder for oral susp.
        Azithromycin 200 mg/5 mL powder for oral susp.
        Azithromycin Teva 200 mg/5 mL powder for oral susp.
        Zithromax 200 mg/5 mL powder for oral susp.
        Powder for susp.: store below 25°C
        Reconstituted susp.: store at room temperature, below 25°C
        After reconstitution of the powder, use the susp. within 5 days; shake immediately prior to use
          ErythromycinTab. erythromycin 250 mg
        Tab. Erythro Teva 250 mg; 500 mg
        Tab. Erythrocin 250 mg; 500 mg
        Tab. Erythroped A 500 mg
        Tab.: store in a dry place, below 25°CAlcohol: may decrease the absorption of erythromycin or enhance effects of alcohol (ethanol); the combination should be avoided
        Erythromycin SF granules for oral susp. 125 mg/5 mL; 250 mg/5 mL; 500 mg/5 mL
        Erythromycin ethyl succinate granules for oral susp. 125 mg/5 mL; 250 mg/5 mL; 500 mg/5 mL
        Erythroped SF 250 mg/5 mL; 500 mg/5 mL
        Primacine granules for oral susp. 250 mg/5 mL
        Granules for susp.: store below 25°C
        Reconstituted susp.: store in a refrigerator (2–8°C); do not freeze
        After reconstitution, use the suspension within 14 days; shake immediately prior to use
          RoxithromycinTab. Rulid 150 mg; 300 mg
        Tab. Roxo 150 mg
        Tab.: store below 25°CAlcohol: no special recommendation
          ClarithromycinTab. Karin 250 mg, 500 mg
        Tab. Klacid SR 500 mg
        Tab. clarithromycin 250 mg, 500 mg
        Tab. Klaricid XL 500 mg
        Prolonged release tab. Mycifor XL 500 mg
        Caplets Klaridex 250 mg
        Tab., caplets: store in the original package in order to protect from light and moisture; store below 25°C (some manufacturers permit excursions up to 30°C)Alcohol: no special recommendation
        Sachet Klaricid adult 250 mgSachet: store in a dry place, below 30°C
        Mix the contents of the sachet with a small amount of water before taking to make the granules easier to swallow
        Klacid paediatric granules for susp. 125 mg/5 mL
        Susp. Clarithromycin 125 mg/5 mL; 250 mg/5 mL
        Oral susp. clarithromycin 125 mg/5 mL; 250 mg/5 mL
        Klaricid paediatric susp. 125 mg/5 mL; 250 mg/5 mL
        Granules for susp.: store below 30°C
        Reconstituted susp.: store at room temperature, below 25°C (up to 30°C according to manufacturer) and use within 14 days from reconstitution; do not refrigerate or freeze the reconstituted suspension; shake immediately prior to use
          AmoxicillinCap. amoxicillin 250 mg; 500 mg
        Cap. Amoxil 250 mg; 500 mg
        Cap. Moxyvit 250 mg
        Cap. Moxyvit forte 500 mg
        Cap. Moxypen forte 500 mg
        Cap.: store in a dry place, below 25°CAlcohol: no special recommendation
        Amoxicillin powder for oral susp. 125 mg/5 mL; 250 mg/5 mL
        Amoxicillin powder for oral susp. SF 125 mg/5 mL; 250 mg/5 mL
        Moxyvit forte powder for oral susp. 250 mg/5 mL
        Moxypen forte powder for susp. 250 mg/5 mL
        Powder for susp.: store in a dry place, below 25°C
        Reconstituted susp.: according to manufacturer instructions, store in a refrigerator (2–8°C) or at room temperature (below 25°C) and use within 7–14 days#; shake immediately prior to use
          Amoxicillin–clavulanic acidTab. Amoxiclav Teva 875 mg
        Tab. Augmentin 250 mg; 500 mg; 875 mg
        Tab. co-amoxiclav 250 mg; 500 mg
        Tab. Maclivan 500 mg
        Tab.: store in the original package in order to protect from moisture; store below 25°C
        Augmentin tab. supplied in an aluminium pouch should be used within 30 days of opening the pouch
        Alcohol: no special recommendation
        Augmentin powder for oral susp. 250 mg/5 mL; 400 mg/5 mL
        Augmentin ES Augmentin powder for oral susp. 600 mg/5 mL
        Co-amoxiclav powder for oral suspension 125 mg/5 mL; 250 mg/5 mL; 400 mg/5 mL
        Maclivan powder for oral suspension 250 mg/5 mL; 400 mg/5 mL
        Powder for susp.: store in the original package in order to protect from moisture; store below 25°C
        Reconstituted susp.: according to manufacturer instructions, store in a refrigerator (2–8°C) and use within 7–10 days#
          DoxycyclineCap. Doxy 100 mg
        Cap. doxycycline 50 mg; 100 mg
        Cap. Vibramycin Hyclate 100 mg
        Tab. Doxylin 100 mg
        Vibramycin-D 100 mg Dispersible tabs
        Vibra-Tabs 100 mg
        Cap., tab.: store in the original package in order to protect from light and moisture; store below 25°C#Skin photosensitivity: sunlight or ultraviolet light exposure increases the risk of photosensitivity; use skin protection and avoid prolonged exposure to sunlight and ultraviolet light; avoid use of tanning equipment.
        Discontinue the treatment at first sign of skin erythema
        Alcohol: ingestion may shorten the half-life of doxycycline and reduce its serum concentration; the combination should be avoided
        Doxycycline powder for susp. 25 mg/5 mL
        Vibramycin monohydrate powder for susp. 25 mg·mL−1
        Powder for susp.: store in the original package in order to protect from light and moisture; store below 25°C#
        Reconstituted susp.: store in the original package in order to protect from light and moisture; store below 25°C (up to 30°C according to manufacturer); use within 14 days from reconstitution; shake immediately prior to use
        Vibramycin calcium syrup 50 mg·mL−1Syrup: store in the original package in order to protect from light and moisture; store below 30°C
          MinocyclineCap. minocycline 50 mg; 100 mg
        Cap. Minoclin 100 mg
        Tab. minocycline 50 mg; 100 mg
        Cap., tab.: store in the original package in order to protect from light; store below 25°CSkin photosensitivity: may cause photosensitivity; use skin protection and avoid prolonged exposure to sunlight and ultraviolet light; avoid use of tanning equipment
        Discontinue the treatment if skin erythema occurs
        Alcohol: no special recommendation
          CefuroximeTab. Zinnat 125 mg; 250 mg; 500 mg
        Tab. Cefuroxime 250 mg
        Tab. store in the original package in order to protect from moisture; store below 30°CAlcohol: no special recommendation
        Zinnat powder for oral susp. 125 mg/5 mL; 250 mg/5 mLPowder for suspension: store in the original package, below 30°C
        Reconstituted susp.: store in a refrigerator (2–8°C); do not freeze
        After reconstitution, use the susp. within 10 days; shake the bottle vigorously before the medication is taken
          CephalexinCap. Cefovit 250 mg; forte 500 mg
        Cap., tab. Cefalexin 250 mg; 500 mg
        Tab. Keflex 250 mg; 500 mg
        Cap.: store in a dry place, below 25°CAlcohol: no special recommendation
        Cefovit powder for oral susp. 125 mg/5 mL;
        Cefovit forte 250 mg/5 mL
        Cefalexin granules for oral susp. 125 mg/5 mL; 250 mg/5 mL
        Keflex granules for oral susp. 125 mg/5 mL; 250 mg/5 mL
        Powder/granules for susp.: store in a dry place, below 25°C
        Reconstituted susp.: according to manufacturer instructions, store in a refrigerator (2–8°C) and use within 10–14 days#; shake well before each use
          SMX-TMPCaplets Diseptyl forte 800 mg/160 mg
        Tab. co-trimoxazole 400 mg/80 mg
        Tab. co-trimoxazole forte 800 mg/160 mg
        Tab. Septrin 400 mg/80 mg
        Tab. Septrin forte 800 mg/160 mg
        Cap., tab.: store in the original package, below 25°CSkin photosensitivity: as been reported with SMX-TMP; use with caution; use skin protection and avoid prolonged exposure to sunlight and ultraviolet light; avoid use of tanning equipment
        Discontinue the treatment if skin erythema occurs
        Alcohol: a disulfiram-like reaction (flushing, sweating, palpitations and drowsiness) may occur if alcohol (0.5–1 L of an alcoholic drink e.g. beer) is ingested
        Susp. Diseptyl 200 mg/40 mg in 5 mL
        Co-trimoxazole paediatric susp. 200 mg/40 mg in 5 mL
        Co-trimoxazole adult susp. 400 mg/80 mg in 5 mL
        Septrin paediatric susp. 200 mg/40 mg in 5 mL
        Septrin adult susp. 400 mg/80 mg in 5 mL
        Susp. Store in a dark and dry place, below 25°C
        Use within 10 days of opening#.
          CiprofloxacinTab. Ciprodex 250 mg; 500 mg; 750 mg
        Tab. ciprofloxacin Teva 250 mg; 500 mg; 750 mg
        Ciprofloxacin 100 mg; 250 mg; 500 mg; 750 mg film-coated tab.
        Tab. Ciproxin 500 mg
        Tab. store in the original package, below 25°CSkin photosensitivity: ciprofloxacin has been shown to cause photosensitivity reactions; use skin protection and avoid prolonged exposure to sunlight and ultraviolet light; avoid use of tanning equipment
        Discontinue the treatment if skin erythema occurs
        Caffeine: ciprofloxacin has been shown to interfere with the metabolism of caffeine leading to increased caffeine concentrations; patients consuming regular large quantities of caffeinated beverages may need to restrict caffeine intake if excessive cardiac or central nervous system stimulation occurs; the effect of this interaction is greater in females
        Ciproxin 250 mg/5 mL, granules and solvent for oral susp.Ciproxin: store the granules and solvent below 25°C; protect the solvent from freezing; avoid inverted storage
        The ready-to-use oral susp. (utilising the individual components) is stable only for 14 days when either stored in a refrigerator (2–8°C) or at temperatures up to 30°C; protect the reconstituted susp. from freezing
          MoxifloxacinTab. Megaxin 400 mg
        Tab., film-coated Moxicloxacin 400 mg
        Tab. Avelox 400 mg
        Tab.: store in the original package in order to protect from moisture; store below 25°CSkin photosensitivity: quinolones have been shown to cause photosensitivity reactions in patients; use skin protection and avoid prolonged exposure to sunlight and ultraviolet light; avoid use of tanning equipment
        Discontinue the treatment if skin erythema occurs
          FluconazoleCap. Flucanol 50 mg; 100 mg; 150 mg; 200 mg
        Cap. fluconazole Teva 150 mg
        Cap. Trican 50 mg, 100 mg, 150 mg, 200 mg
        Cap. fluconazole/Azocan 50 mg, 150 mg, 200 mg
        Cap.: store in a dry place below 25°C#Alcohol: no special recommendation
        Fluconazole powder for oral susp. (Genus Pharmaceuticals) 50 mg/5 mL
        Diflucan powder for oral suspension 10 mg/mL; 40 mg/mL
        Powder for susp.: store in a dry place, below 25°C
        Reconstituted susp. store in a refrigerator (2–8°C) or at temperatures up to 30°C use within 14–28 days#; protect the reconstituted susp. from freezing; shake well before administration
          ItraconazoleCap. Itranol 100 mg
        Cap. itraconazole 100 mg
        Cap.: store in the original package in order to protect from moisture; store below 25°CSkin photosensitivity: uncommon (≤2%); case reports have been described
        Use skin protection and avoid prolonged exposure to sunlight and ultraviolet light; avoid use of tanning equipment
        Discontinue the treatment if skin erythema occurs
        Alcohol: no special recommendation
        Cap. SporanoxSporanox cap.: up to 30°C
        Sporanox oral solution 10 mg·mL−1Powder for susp.: store below 25°C; use within 30 days of opening
        Itraconazole 10 mg·mL−1 oral solution
        Expectorants and cough suppressants
          AcetylcysteineReolin effervescent tablets 200 mg
        Siran 200 mg effervescent tablets
        Effervescent tablets: store in the original package in order to protect from moisture; store below 25°C; close the tube immediately after taking out the tablet
        After dissolving the tablet, it must be used immediately
        Reolin: use within 2 years after the first opening or until the expiry date
        Siran: use within 4 weeks after the first opening
        Alcohol: no special recommendation
        Sachet acetylcysteine 200 mg powder for oral solutionPowder for oral solution: store in the original package in order to protect from moisture
        Reconstituted solution: the product must be used immediately
          GuaifenesinResyl syrup 100 mg/5  mL (contains 6% alcohol by volume)
        Benylin syrup for children's chesty coughs 50 mg/5 mL
        Benylin syrup Mucus Cough Max honey and lemon flavour 100 mg/5 mL (contains 4.7% alcohol by volume)
        Oral solution Benylin Mucus Cough Max menthol flavour 100 mg/5 mL (contains 4.7% alcohol by volume)
        Boots chesty cough relief 100 mg/5 mL oral solution
        Boots chesty cough syrup 6 years plus (contains alcohol)
        Boots mucus cough relief 100 mg/5 mL oral solution
        Covonia chesty cough SF syrup
        Robitussin chesty cough medicine 100 mg/5mL−1 oral solution (contains 2.7% v/v alcohol)
        Lemsip cough for chesty cough 50 mg/5 mL oral solution
        Syrup: store in the original package, below 25°C
        Resyl: store below 30°C; use within 6 months of opening
        Benylin honey and lemon flavour: use within 6 months of opening
        Oral solution: store below 25°C
        Benylin menthol flavour: store in the original container to protect from light and use within 4 weeks of opening
        Alcohol: some products contain alcohol; therefore, these formulations can emphasise the effect of sedatives (including alcohol) and myorelaxants
        Avoid concurrent use or use caution when motor skills are required
        Other oral medications
          PrednisoneTab. prednisone 1 mg; 5 mg; 20 mg
        Modified-release tab. Lodotra 1 mg; 2 mg; 5 mg
        Tab.: store in a dark and dry place, below 25°C
        Tab. prednisone 1 mg: use within 2 months of opening (but not after the expiry date)
        Lodotra: store below 25°C and use within 14 weeks of opening (but not after the expiry date)
        Alcohol: no special recommendation
          PrednisoloneTab. Pevanti 2.5 mg; 5 mg; 10 mg; 20 mg; 25 mg
        Tab. prednisolone 1 mg, 2.5 mg; 5 mg; 10 mg; 20 mg; 25 mg; 30 mg
        Tab. prednisolone gastro-resistant 1 mg; 2.5 mg; 5 mg
        Soluble tab. prednisolone 5 mg
        Tab. (also gastro-resistant and soluble tab.): store in the original package in order to protect from light and moisture, below 25°C
        Pevanti: use within 6 months of opening (but not after the expiry date)
        Alcohol: some products contain alcohol; avoid concurrent use of ethanol with these formulations or use caution when motor skills are required
        Danalone syrup 15 mg/5 mL (contains alcohol)Syrup: store below 25°C but not in the refrigerator; close firmly, and prevent penetration of air and moisture
        Prednisolone Dompe 1 mg·mL−1 oral solution (single-dose containers)
        Prednisolone 10 mg·mL−1 oral solution
        Dompe: before opening, store in the original package; store below 30°C
        Once opened, the container must be discarded once the dose is removed
        Prednisolone 10 mg·mL−1: keep the container in the outer carton in order to protect from light
        Before opening, store in a refrigerator (2–8°C)
        Once opened, store below 25°C and use within 3 months
          Proton pump inhibitors
           OmeprazoleCaplets Omepradex 10 mg; 20 mg; 40 mg
        Caplets Omepradex-Z 20 mg
        Caplets: store in the original package, below 25°CSkin photosensitivity: has been described but is rare (≤0.1%)
        Alcohol: no special recommendation
        Cap. Losec 20 mg (Israel)
        Cap. Omepra 10 mg; 20 mg; 40 mg
        Cap. Omeprix 20 mg
        Cap. Losec 10 mg; 20 mg; 40 mg (Europe)
        Cap. Mepradec gastro-resistant 10, 20 mg
        Cap. Omeprazole gastro-resistant 10 mg; 20 mg; 40 mg
        Cap. Prenome 10 mg; 20 mg; 40 mg
        Cap. Omeprazole 10 mg; 20 mg; 40 mg
        Tab. Omeprazole Gastro-resistant 10 mg; 20 mg; 40 mg
        Pyrocalm Control 20 mg gastro-resistant tablets
        Cap., tab.: store below 25°C
        Store in the original package in order to protect from moisture, below 25–30°C and use within 3 months of opening of the bottle#
           EsomeprazoleTab. esomeprazole Inovamed 20 mg; 40 mg
        Tab. Nexium 20 mg; 40 mg
        Tab. esomeprazole gastro-resistant 20 mg; 40 mg
        Cap. Emozul gastro-resistant 20 mg, 40 mg
        Cap. esomeprazole gastro-resistant 20 mg; 40 mg
        Ventra gastro-resistant capsules 20 mg; 40 mg
        Tab., cap.: store in the original package in order to protect from moisture
        Store below 25–30°C# and use within 3–6 months after first opening of the bottle#
        Skin photosensitivity: has been described in the literature but is rare (≤0.1%)
        Alcohol: no special recommendation
        Sachet Nexium 10 mg gastro-resistant granules for oral susp.Granules for oral susp.: use within 30 min after reconstitution
           LansoprazoleCap. lansoprazole 15 mg; 30 mg
        Cap. Lanton 15 mg; 30 mg
        Cap. lansoprazole gastro-resistant 15 mg; 30 mg
        Orodispersible tab. lansoprazole 15 mg; 30 mg
        Zoton Fas-Tab 15 mg; 30 mg
        Cap., tab.: store in the original package in order to protect from light and moisture; store below 25°C
        Use within 2 months to 100 days after first opening of the bottle#
        Skin photosensitivity: has been described in the literature but is rare (≤0.1%)
        Alcohol: no special recommendation
           PantoprazoleTab. Contrololc 20 mg; 40 mg
        Pantoloc Control 20 mg gastro-resistant tablets
        Tab. Pantoprazole gastro-resistant 20 mg; 40 mg
        Tab. store in the original package in order to protect from moisture; store below 25°C
        Use within 6 months after first opening of the bottle#
        Skin photosensitivity: has been described in the literature (but the frequency cannot be estimated from the available data); use with caution
        Alcohol: no special recommendation
          H2 blockers
           FamotidineTab. famotidine Teva 20 mg; 40 mg
        Tab. Famo 20 mg; 40 mg
        Tab. Gastro 10 mg; 20 mg; 40 mg
        Tab. Pepcid 20 mg; 40 mg
        Tab. store in the original package in order to protect from light and moisture; store below 25°CAlcohol: no special recommendation
        Pepcid powder for oral susp. 40 mg/5 mLPowder for susp.: store in the original package at 25°C; excursions permitted to 15–30°C
        Reconstituted susp.: after reconstitution, use the suspension within 30 days; protect from freezing
           RanitidineTab. Zaridex 150 mg; 300 mg
        Tab. Ranitidine film-coated 150 mg; 300 mg
        Tab. Zantac 75 mg; 150 mg; 300 mg
        Tab.: store in the original package, below 25°CAlcohol: co-ingestion of alcohol (1.5–2 drinks) while on ranitidine may result in higher blood alcohol concentrations, although the clinical significance is uncertain
        In addition, some products contain alcohol; avoid concurrent use of ethanol with these formulations or use caution when motor skills are required
        Zantac syrup 150 mg/10 mL (contains ∼7.5% w/v alcohol)Syrup: store below 25°C and use within 28 days of opening
        Ranitidine 150 mg/10 mL oral solution (contains ∼8% w/v alcohol)
        Ranitidine 30 mg·mL−1 oral solution (contains ∼7.5% w/v alcohol)
        Oral solution: store in original carton/bottle in order to protect from light; store below 25°C
          Antacids
           Aluminium hydroxide,   magnesium hydroxide and   dimethicone/simethiconeMaalox Plus chewable tablets (200 mg magnesium hydroxide, 200 mg hydrated aluminium oxide and 25 mg dimethicone in a tablet)Tab.: store in the original package, below 25°CAlcohol: no special recommendation
        Maalox Plus oral susp. (225 mg aluminium hydroxide, 200 mg magnesium hydroxide and 25 mg simethicone in 5 mL)Oral susp.: store below 25°C and use within 28 days of opening; shake well before administration
           Calcium carbonateChewable tab. Tums
        Chewable tab. N-Zarevet
        Chewable tab.
        Chewable tab.: store in the original package, below 25°C
        N-Zarevet: use within 12 months after first opening of the bottle
        Alcohol: no special recommendation
           Calcium carbonate and   magnesium carbonateChewable tab. Rennie
        Chewable tab. Rolaids
        Chewable tab.: store in the original package, below 25°CAlcohol: no special recommendation
        Rolaids mint liquid (550 mg calcium carbonate and 110 mg magnesium hydroxide in 5 mL)Liquid: do not freeze
           Calcium carbonate, sodium   bicarbonate and sodium   alginateChewable tab. GavisconChewable tab.: store in the original package in order to protect from moisture; below 25–30°C#Alcohol: no special recommendation
        Gaviscon peppermint liquidLiquid: store in the original package, below 25–30°C (according to manufacturer instructions) and use within 6 months of opening
        Gaviscon liquid sachets mint flavour (500 mg sodium alginate, 267 mg sodium bicarbonate and 160 mg calcium carbonate per 10-mL dose)Liquid sachet: store in the original package, below 25°C; discard any unused contents
        Bronchodilators: inhalers and solution
          Salbutamol MDIVentolin inhaler CFC-Free 100 µg per dose
        Salbutrim CFC-free inhaler 100 µg per dose
        Ventolin, Salbutrim: store below 30°C; protect from frost and direct sunlight
        If the inhaler gets very cold, take the metal container out of the plastic case and warm it in your hands for a few minutes; do not use anything else to warm it up
        Alcohol: no special recommendation
        Easyhaler Salbutamol 100 µg per dose, 200 µg per dose
        Salamol Easi-Breathe 100 µg per dose
        Easyhaler: store in a dry place, at a temperature below 25°C; use within 6 months after first opening of foil pouch
        Salbulin MDPI NovolizerSalbulin: store below 30°C; use within 6 months after first opening the container
          Ipratropium MDIMDI Atrovent 20 µg per doseMDI: store below 25°C (Europe) or 30°C (Israel); protect from frost and direct sunlight; do not expose to temperature >50°CAlcohol: no special recommendation
          Salbutamol (solution)Ventolin respirator solution 5 mg·mL−1 (0.5% w/v)Ventolin respirator solution: store below 25–30°C#; protect from light; discard any contents remaining 1 month after opening the bottle
        A fresh solution should be prepared before each usage
        Alcohol: no special recommendation
        Ventolin Nebules 2.5 mg/2.5 mL (0.1% w/v), 5 mg/2.5 mL (0.2% w/v)
        Ampules Salbutamol 2.5 mg/2.5 mL nebuliser solution; 5 mg/2.5 mL
        Ventolin Nebules, Ampules Salbutamol: store below 25–30°C#; protect from light after removal from the foil overwrap pouch
        Use nebules 3 months after removal from the foil pouch; use immediately after first opening of the ampule and discard any unused contents
          Ipratropium (solution)Aerovent respirator solution 0.25 mg·mL−1Respirator solution: store below 25°C; do not freeze
        Discard any contents remaining 1 month after opening the bottle
        A fresh solution should be prepared before each usage
        Alcohol: no special recommendation
        Atrovent 250 UDVs, 1 mL; Atrovent UDVs, 2 mL–0.25 mg·mL−1 vials
        Ampules ipratropium bromide 250 µg/1 mL nebuliser solution; 500 µg/2 mL nebuliser solution
        Atrovent 250 UDVs, Atrovent UDVs, Ampules Ipratropium bromide: keep the vials in the outer carton; store below 25°C
        Use immediately after first opening of the ampule and discard any unused contents
        Other inhaled medications
          Isotonic saline (sodium  chloride 0.9% w/v)Ampules sodium chloride 0.9% Fresenius 5 mL; 10 mL; 20 mL per ampule
        Saline nebuliser solution Arrow 2.5 mL per ampule
        Saline Steripoules 2.5 mL
        Ampules: store below 25°C; do not refrigerate or freeze
        Saline nebuliser solution
        Strips of 10 ampules are overwrapped in an aluminium foil pack; ampules removed from the foil overwrap should be used within 90 days
        Alcohol: no special recommendation
          Hypertonic saline (sodium  chloride 3%, 6%, 7% w/v)INH Solution MucoClear (sodium chloride) 3%, 4 mL per ampule
        INH Solution MucoClear (sodium chloride) 6%, 4 mL per ampule
        MucoClear: store below 25°C; do not refrigerate or freezeAlcohol: no special recommendation
        INH Solution PulmoSal 7%, (pH+) 4 mL per vialPulmosal: store at room temperature, 15–30°C; avoid excessive heat and protect from freezing
        Inhaled antimicrobials
          CMSVial Coliracin 1 000 000 units per vial
        Vial CMS 1 000 000 IU powder for solution for injection
        Vial Colomycin 1 000 000 IU, 2 million IU
        Promixin, 1 000 000 IU powder for nebuliser solution
        Vial: store below 25°C; protect from light
        Use immediately after reconstitution with 0.9% sodium chloride; solutions may be used within 24 h when stored in a refrigerator (2–8°C)
        Alcohol: no special recommendation
        Colobreathe 1 662 500 IU inhalation powder, hard capsules (∼125 mg CMS)Colobreathe: store in the original package until immediately before use in order to protect from moisture; store below 25°C
          TobramycinVial tobramycin 40 mg·mL−1 solution for injectionVial for injection: store in the outer carton in order to protect from light; store below 25°C
        Use immediately after reconstitution with 0.9% sodium chloride
        Solutions may be used within 24 h when stored in a refrigerator (2–8°C)
        A fresh solution should be prepared before each usage
        Alcohol: no special recommendation
        Vial Nebcin injection 40 mg·mL−1Ready-to-use nebuliser solution: store in the original package in order to protect from light and moisture; store in a refrigerator (2–8°C); do not freeze
        Bramitob 300 mg/4 mL nebuliser solution, single-dose containerThe contents of the whole ampule should be used directly after opening; opened ampules should never be stored for re-use
        TOBI Podhaler 28 mg per capsule inhalation powder, hard capsulesTOBI pouch, Tymbrineb foil pouch, Tobramycin pouch (intact or opened); may be stored at room temperature (up to 25°C) for up to 28 days
        TOBI 300 mg/5 mL nebuliser solution, single-use ampuleBramitob bags (intact or opened) may be stored at room temperature (up to 25°C) for up to 3 months
        Vantobra pouch (intact or opened) may be stored at room temperature (up to 25°C) for up to 4 weeks
        TOBI Podhaler 28 mg per capsule inhalation powderCapsules for inhalation: TOBI Podhaler capsules must always be stored in the blister to protect from moisture and only removed immediately before use; store below 30°C
        Podhaler device: store the inhaler in its tightly closed case when not in use; each Podhaler device and its case are used for 7 days and then discarded and replaced
          GentamicinAmpule gentamicin B. Braun 1 mg·mL−1; 3 mg·mL−1 solution for infusion
        Ampule gentamicin 10 mg·mL−1 solution
        Ampule Genticin 40 mg·mL−1 injectable
        Ampule Cidomycin 80 mg/2 mL solution for injection
        Ampules for injection: store in the outer carton in order to protect from light; store below 25°C; use immediately after reconstitution with 0.9% sodium chloride; a fresh solution should be prepared before each usageAlcohol: no special recommendation

        Cap: capsules; tab: tablets: susp.: suspension; SF: sugar free; SR: sustained release; SMX: sulfamethoxazole; TMP: trimethoprim; MDI: metered-dose inhaler; CFC: chlorofluorocarbon; CMS: colistimethate sodium.#: see leaflet, as different instructions for different manufacturers [23].

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        Vol 5 Issue 4 Table of Contents
        ERJ Open Research: 5 (4)
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        Recommendations for travelling with bronchiectasis: a joint ELF/EMBARC/ERN-Lung collaboration
        Michal Shteinberg, Barbara Crossley, Tal Lavie, Sima Nadler, Jeanette Boyd, Felix C. Ringshausen, Tim Aksamit, James D. Chalmers, Pieter Goeminne
        ERJ Open Research Oct 2019, 5 (4) 00113-2019; DOI: 10.1183/23120541.00113-2019

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        Recommendations for travelling with bronchiectasis: a joint ELF/EMBARC/ERN-Lung collaboration
        Michal Shteinberg, Barbara Crossley, Tal Lavie, Sima Nadler, Jeanette Boyd, Felix C. Ringshausen, Tim Aksamit, James D. Chalmers, Pieter Goeminne
        ERJ Open Research Oct 2019, 5 (4) 00113-2019; DOI: 10.1183/23120541.00113-2019
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