Characteristics of exacerbators in the US Bronchiectasis and NTM Research Registry: a cross-sectional study (2024)

Abstract

Background Exacerbations of non-cystic fibrosis bronchiectasis (bronchiectasis) are associated with reduced health-related quality of life and increased mortality, likelihood of hospitalisation, and lung function decline. This study investigated patient clinical characteristics associated with exacerbation frequency.

Methods A cross-sectional cohort study of patients ≥18 years with bronchiectasis enrolled in the US Bronchiectasis and Nontuberculous Mycobacteria (NTM) Research Registry (BRR) September 2008–March 2020. Patients were stratified by exacerbation frequency in their 2 years before enrollment. Patient demographics, respiratory symptoms, healthcare resource utilisation, microbiology, modified bronchiectasis severity index (mBSI), and select comorbidities were collected at enrollment. Patient characteristics associated with exacerbation frequency were assessed using a negative binomial model.

Results The study included 2950 patients (mean age 65.6 years; 79.1% female). Frequency of moderate to severe airway obstruction (forced expiratory volume in 1 s [FEV₁] % predicted <50%; most recent measure) was 15.9%, 17.8%, and 24.6% in patients with 1, 2, and ≥3 exacerbations versus 8.9% in patients with 0 exacerbations; severe disease (mBSI) was 27.8%, 24.2%, and 51.1% versus 13.2%; respiratory hospitalisation was 24.5%, 33.0%, and 36.5% versus 4.1%; and Pseudomonas aeruginosa infection was 18.8%, 23.4%, and 35.2% versus 11.9%. In multivariable model analysis, respiratory hospitalisation, cough, haemoptysis, P. aeruginosa, younger age, lower FEV₁% predicted, asthma, and gastroesophageal reflux disease were associated with more exacerbations.

Conclusions These findings demonstrate a high disease burden, including increased respiratory symptoms, healthcare resource utilisation, and P. aeruginosa infection in patients with bronchiectasis and multiple exacerbations.

Footnotes

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Conflict of interest: All authors of this article have agreed to submit the manuscript, and all a uthors declare that there are no conflicts of interest

Conflict of interest: : Nicole C Lapinel reports receiving consulting fees and serving on the advisory board panel for Insmed Incorporated and that Louisiana State University Health Sciences Center received clinical trial support from Insmed Incorporated. Radmila Choate and Andreas Schmid have nothing to disclose. Timothy R Aksamit reports no personal grant/research support from Insmed Incorporated or other pharma; clinical trial design and participation with AstraZeneca, Insmed Incorporated, Johnson & Johnson, Redhill Biopharma, Spero Therapeutics, and Zambon, with all support going to the Mayo Foundation for Medical Education and Research; and is the Medical Director of Bronchiectasis and NTM 360 for the COPD Foundation. Joseph Feliciano and Sebastian Fucile are employees and shareholders of Insmed Incorporated. Kevin L Winthrop reports grant/research support and consulting fees from AN2 Therapeutics, Insmed Incorporated, Paratek, Red Hill Biopharma, Renovion, and Spero Therapeutics and participation on a data safety monitoring board or advisory board for Red Hill Biopharma. Mark L Metersky reports receiving consulting fees from AN2 Therapeutics, Boehringer Ingelheim, Insmed Incorporated, Renovion, and Zambon.

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