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  3. Symptoms, risk of future exacerbations, and response to long-term macrolide treatment in bronchiectasis: an observational study

Symptoms, risk of future exacerbations, and response to long-term macrolide treatment in bronchiectasis: an observational study

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Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Sibila, O
  • Stobo, J
  • Perea, L
  • Gao, YH
  • Xu, JF
  • Lind, H
  • Viligorska, K
  • Spinou, A
  • Polverino, E
  • Ringshausen, FC
  • Vendrell, M
  • Burgel, PR
  • Haworth, CS
  • Loebinger, MR
  • Lorent, N
  • Dhar, R
  • Choi, H
  • Chotirmall, SH
  • De Soyza, A
  • Hurst, JR
  • Brown, JS
  • van der Eerden, M
  • Kauppi, P
  • Johnson, E
  • Dimakou, K
  • Bossios, A
  • Torres, A
  • Blasi, F
  • Shteinberg, M
  • Elborn, SJ
  • Goeminne, PC
  • Aliberti, S
  • Jayaram, L
  • Karalus, N
  • Taylor, SL
  • Martin, ML
  • Burr, L
  • Wong, CR
  • Terpstra, L
  • Altenburg, J
  • Boersma, W
  • Chalmers, J

Grupos

Abstract

Background Previous studies have suggested that daily symptoms are a marker of bronchiectasis disease activity and could therefore identify patients at increased risk of exacerbation. However, international bronchiectasis guidelines recommend long-term macrolide treatment only in patients with three or more exacerbations per year. We aimed to investigate if symptoms independently predict future exacerbations and therefore identify additional responders to long-term macrolide treatment. Methods We used data from the EMBARC registry, a multicentre international bronchiectasis database. Baseline symptoms were evaluated with the quality-of-life bronchiectasis questionnaire respiratory symptoms score (QoL-B-RSS), followed-up for at least 1 year, and were related to the future risk of exacerbations. We subsequently conducted a post-hoc pooled analysis of three randomised controlled trials of macrolides (ie, BLESS, BAT, and EMBRACE) in 341 participants with bronchiectasis to determine if baseline symptoms were associated with response to long-term macrolide treatment, using a negative binomial regression model. Findings 9466 patients from the 19 324 patients included in the EMBARC registry had available QoL-B-RSS assessment at baseline and 1-year follow-up. The median age was 68 years (IQR 58-74), 5763 (60<middle dot>9%) were female, and 3703 (39<middle dot>1%) were male. The median Bronchiectasis Severity Index score was 7 (4-10) and Pseudomonas aeruginosa was present in the sputum of 2041 (21<middle dot>6%) patients within 12-months of baseline. Previous exacerbations (rate ratio (RR) for every additional exacerbation 1<middle dot>11, 95% CI 1<middle dot>10-1<middle dot>12; p<0<middle dot>0001) and symptoms (RR for every 10 points lower QoL-B-RSS 1<middle dot>10, 1<middle dot>09-1<middle dot>11; p<0<middle dot>0001) were identified as independent risk factors for future exacerbations. The number of exacerbations during 1-year of follow-up was similar between patients with three or more exacerbations at baseline and average symptom scores (QoL-B-RSS 60-70; RR 1<middle dot>58, 95% CI 1<middle dot>48-1<middle dot>69) and the group with no previous exacerbations but high symptom scores (RR 1<middle dot>55, 1<middle dot>41-1<middle dot>70). The same pattern was observed in the post-hoc analysis of randomised controlled trials, both in the macrolide and placebo groups. The number-needed-to-treat to prevent exacerbations with long-term macrolide therapy was similar for patients selected based on frequent exacerbations (1<middle dot>45, 95% CI 1<middle dot>08-2<middle dot>24) and in those with few previous exacerbations, but high symptom scores 1<middle dot>43 (1<middle dot>06-2<middle dot>18). Interpretation Our results suggest that symptoms are an independent risk factor for future exacerbations in bronchiectasis. Patients who are highly symptomatic derive a similar benefit from macrolide treatment as patients with a high baseline exacerbation frequency. Copyright (c) 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Datos de la publicación

ISSN/ISSNe:
2213-2600, 2213-2619

Lancet Respiratory Medicine  ELSEVIER SCI LTD

Tipo:
Article
Páginas:
911-920
PubMed:
40885209
Factor de Impacto:
11,120 SCImago ℠
Cuartil:
Q1 SCImago ℠

Citas Recibidas en Web of Science: 20

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