Bronchiectasis and asthma: Data from the European Bronchiectasis Registry (EMBARC).
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Polverino Eva, Dimakou Katerina, Traversi Letizia, Bossios Apostolos, Haworth Charles S, Loebinger Michael R, De Soyza Anthony, Vendrell Montserrat, Burgel Pierre-Régis, Mertsch Pontus, McDonnell Melissa, Škrgat Sabina, Maiz Carro Luis, Sibila Oriol, van der Eerden Menno, Kauppi Paula, Hill Adam T, Wilson Robert, Milenkovic Branislava, Menendez Rosario, Murris Marlene, Digalaki Tonia, Crichton Megan L, Borecki Sermin, Obradovic Dusanka, Nowinski Adam, Amorim Adelina, Torres Antoni, Lorent Natalie, Welte Tobias, Blasi Francesco, Van Braeckel Eva, Altenburg Josje, Shoemark Amelia, Shteinberg Michal, Boersma Wim, Elborn J Stuart, Aliberti Stefano, Ringshausen Felix C, Chalmers James D, Goeminne Pieter C, EMBARC registry investigators
Аннотация
OBJECTIVE: The aim of this study was to evaluate whether patients with bronchiectasis and asthma (BE+A) had a different clinical phenotype and different outcomes compared with patients with bronchiectasis without concomitant asthma.
METHODS: A prospective observational pan-European registry (European Multicentre Bronchiectasis Audit and Research Collaboration) enrolled patients across 28 countries. Adult patients with computed tomography-confirmed bronchiectasis were reviewed at baseline and annual follow-up visits using an electronic case report form. Asthma was diagnosed by the local investigator. Follow-up data were used to explore differences in exacerbation frequency between groups using a negative binomial regression model. Survival analysis used Cox proportional hazards regression.
RESULTS: Of 16,963 patients with bronchiectasis included for analysis, 5,267 (31.0%) had investigator-reported asthma. Patients with BE+A were younger, were more likely to be female and never smokers, and had a higher body mass index than patients with bronchiectasis without asthma. BE+A was associated with a higher prevalence of rhinosinusitis and nasal polyps as well as eosinophilia and Aspergillus sensitization. BE+A had similar microbiology but significantly lower severity of disease using the bronchiectasis severity index. Patients with BE+A were at increased risk of exacerbation after adjustment for disease severity and multiple confounders. Inhaled corticosteroid (ICS) use was associated with reduced mortality in patients with BE+A (adjusted hazard ratio 0.78, 95% CI 0.63-0.95) and reduced risk of hospitalization (rate ratio 0.67, 95% CI 0.67-0.86) compared with control subjects without asthma and not receiving ICSs.
CONCLUSIONS: BE+A was common and was associated with an increased risk of exacerbations and improved outcomes with ICS use. Unexpectedly we identified significantly lower mortality in patients with BE+A.