Use of inhaled corticosteroids in bronchiectasis: data from the European Bronchiectasis Registry (EMBARC).
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Pollock Jennifer, Polverino Eva, Dhar Raja, Dimakou Katerina, Traversi Letizia, Bossios Apostolos, Haworth Charles, Loebinger Michael R, De Soyza Anthony, Vendrell Montserrat, Burgel Pierre Regis, Mertsch Pontus, McDonnell Melissa Jane, Skgrat Sabina, Maiz-Carro Luis, Sibila Oriol, van der Eerden Menno, Kauppi Paula, Hill Adam T, Wilson Robert, Milenkovic Branislava, Menéndez Rosario, Murris Marlene, Crichton Megan L, Borecki Sermin, Obradovic Dusanka, Irfan Muhammed, Eshenkulova Venera, Nowinski Adam, Amorim Adelina, Torres Antoni, Lorent Natalie, Welte Tobias, Blasi Francesco, Van Braeckel Eva, Altenburg Josje, Shteinberg Michal, Boersma Wim, Elborn Joseph Stuart, Aliberti Stefano, Ringshausen Felix C, Goeminne Pieter, Chalmers James D
Аннотация
METHODS: Patients with bronchiectasis were enrolled into the European Bronchiectasis Registry from 2015 to 2022. Patients were grouped into ICS users and non-users at baseline and clinical characteristics associated with ICS use were investigated. Patients were followed up for clinical outcomes of exacerbation, hospitalisation and mortality for up to 5 years. We evaluated if elevated blood eosinophil counts (above the laboratory upper limit of normal) modified the effect of ICS on exacerbations.
RESULTS: 19 324 patients were included for analysis and 10 109 (52.3%) were recorded as being prescribed ICS at baseline. After exclusion of patients with a history of asthma, COPD and/or ABPA, 3174/9715 (32.7%) patients with bronchiectasis were prescribed ICS. Frequency of ICS use varied across countries, ranging from 17% to 85% of included patients. ICS users had more severe disease, with significantly worse lung function, higher Bronchiectasis Severity Index scores and more frequent exacerbations at baseline (p<0.0001). Overall, ICS users did not have a reduced risk of exacerbation or hospitalisation during follow-up, but a significant reduction in exacerbation frequency was observed in the subgroup of ICS users with elevated blood eosinophil counts (relative risk 0.70, 95% CI 0.59 to 0.84, p<0.001).
CONCLUSION: ICS use is common in bronchiectasis, including in those not currently recommended ICS according to bronchiectasis guidelines. ICS use may be associated with reduced exacerbation frequency in patients with elevated blood eosinophils.