TY - JOUR
T1 - Bronchiectasis and asthma
T2 - Data from the European Bronchiectasis Registry (EMBARC)
AU - Polverino, Eva
AU - Dimakou, Katerina
AU - Traversi, Letizia
AU - Bossios, Apostolos
AU - Haworth, Charles S.
AU - Loebinger, Michael R.
AU - de Soyza, Anthony
AU - Vendrell, Montserrat
AU - Burgel, Pierre-R. gis
AU - Mertsch, Pontus
AU - McDonnell, Melissa
AU - Škrgat, Sabina
AU - Maiz Carro, Luis
AU - Sibila, Oriol
AU - van der Eerden, Menno
AU - Kauppi, Paula
AU - Hill, Adam T.
AU - Wilson, Robert
AU - Milenkovic, Branislava
AU - Menendez, Rosario
AU - Murris, Marlene
AU - Digalaki, Tonia
AU - Crichton, Megan L.
AU - Borecki, Sermin
AU - Obradovic, Dusanka
AU - Nowinski, Adam
AU - Amorim, Adelina
AU - Torres, Antoni
AU - Lorent, Natalie
AU - Welte, Tobias
AU - Blasi, Francesco
AU - van Braeckel, Eva
AU - Altenburg, Josje
AU - Shoemark, Amelia
AU - Shteinberg, Michal
AU - Boersma, Wim
AU - Elborn, J. Stuart
AU - Aliberti, Stefano
AU - Ringshausen, Felix C.
AU - Chalmers, James D.
AU - EMBARC Registry Investigators
AU - Goeminne, Pieter C.
N1 - Publisher Copyright: © 2024 The Authors
PY - 2024
Y1 - 2024
N2 - Background: Asthma is commonly reported in patients with a diagnosis of bronchiectasis. 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.
AB - Background: Asthma is commonly reported in patients with a diagnosis of bronchiectasis. 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.
KW - Asthma
KW - eosinophils
KW - exacerbations
KW - registry
UR - http://www.scopus.com/inward/record.url?scp=85187974352&partnerID=8YFLogxK
U2 - 10.1016/j.jaci.2024.01.027
DO - 10.1016/j.jaci.2024.01.027
M3 - Article
C2 - 38401857
SN - 0091-6749
JO - Journal of allergy and clinical immunology
JF - Journal of allergy and clinical immunology
ER -