Characterization and Comparison of The "Frequent Exacerbator Phenotype" in Non-Cystic Fibrosis Bronchiectasis Patients in a TB-Endemic Country: A Hospital-Based Comparative Study.

BACKGROUND

Bronchiectasis is a chronic lung disease characterized by permanent dilatation of the bronchi. Frequent exacerbations are associated with accelerated lung function decline and increased mortality risk. This study aimed to identify factors associated with the frequent exacerbator phenotype among patients with non-cystic fibrosis (non-CF) bronchiectasis receiving follow-up care in Ethiopia.

METHODS

A comparative institution-based study was conducted among 114 patients with non-CF bronchiectasis attending follow-up clinics. Based on the number of exacerbations in the preceding year, participants were categorized into two groups: frequent exacerbators (≥3 exacerbations per year; n = 34) and non-frequent exacerbators (<3 exacerbations per year; n = 80). Data were collected through structured interviews and review of electronic medical records.

RESULTS

The mean age of participants was 49.5 years (SD ±15.1). Most participants were female (55%) and residents of Addis Ababa (66%). Frequent exacerbators constituted 30% of the study population. Factors independently associated with frequent exacerbations included age >65 years (AOR = 3.7, 95% CI: 2.89-19.47), residence outside Addis Ababa (AOR = 9.7, 95% CI: 2.35-40.07), lack of formal education (AOR = 17.2, 95% CI: 1.78-66.98), smoking (AOR = 6.2, 95% CI: 1.25-31.15), resting oxygen saturation <88% (AOR = 10.1, 95% CI: 1.87-54.73), comorbid asthma (AOR = 4.3, 95% CI: 1.34-16.41), and higher dyspnea grades (grade III: AOR = 8.6; grade IV: AOR = 14.2).

CONCLUSION

Approximately one-third of patients with bronchiectasis attending follow-up at Tikur Anbessa Specialized Hospital experienced frequent exacerbations. Advanced age, residence outside Addis Ababa, low educational status, smoking, hypoxemia, comorbid asthma, and severe dyspnea were significant determinants of the frequent exacerbator phenotype.