Bronchiectasis and asthma: Data from the European Bronchiectasis Registry (EMBARC) - 05/06/24

Doi : 10.1016/j.jaci.2024.01.027

Eva Polverino, MD ^a, Katerina Dimakou, PhD ^b, Letizia Traversi, MD ^a, Apostolos Bossios, PhD ^c,^d, Charles S. Haworth, MD ^e, Michael R. Loebinger, PhD ^f, Anthony De Soyza, PhD ^g,^h, Montserrat Vendrell, MD ⁱ, Pierre-Régis Burgel, PhD ^l,^j,^k, Pontus Mertsch, MD ^l,^m, Melissa McDonnell, PhD ⁿ, Sabina Škrgat, MD ^o,^p,^q, Luis Maiz Carro, MD ^r, Oriol Sibila, PhD ^s,^t, Menno van der Eerden, PhD ^u, Paula Kauppi, PhD ^v, Adam T. Hill, MD ^w, Robert Wilson, MD ^e, Branislava Milenkovic, PhD ^x,^y, Rosario Menendez, MD ^z, Marlene Murris, MD ^aa, Tonia Digalaki, MD ^b, Megan L. Crichton, PhD ^bb, Sermin Borecki, MD ^cc, Dusanka Obradovic, PhD ^dd,^ee, Adam Nowinski, PhD ^ff, Adelina Amorim, MD ^gg, Antoni Torres, MD ^hh, Natalie Lorent, PhD ⁱⁱ, Tobias Welte, MD ^jj,^kk,^ll, Francesco Blasi, MD ^mm,ⁿⁿ, Eva Van Braeckel, PhD ^oo,^pp, Josje Altenburg, PhD ^qq, Amelia Shoemark, PhD ^bb, Michal Shteinberg, PhD ^rr,^ss, Wim Boersma, MD ^tt, J. Stuart Elborn, MD ^uu, Stefano Aliberti, MD ^vv,^ww, Felix C. Ringshausen, MD ^jj,^kk,^ll, James D. Chalmers, PhD ^bb,^⁎ , Pieter C. Goeminne, MD ^xx
on behalf of the
EMBARC registry investigators
^a Pneumology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca, CIBERES, Barcelona, Spain
^b Fifth Respiratory Department and Bronchiectasis Unit, General Hospital for Chest Diseases “Sotiria,” Athens, Greece
^c Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
^d Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
^e Cambridge Centre for Lung Infection, Royal Papworth Hospital and University of Cambridge, Cambridge, United Kingdom
^f National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College London, London, United Kingdom
^g Population and Health Science Institute, Newcastle University, Newcastle, United Kingdom
^h NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle, United Kingdom
ⁱ Department of Pulmonology, Girona Biomedical Research Institute Dr Josep Trueta University Hospital (IDIBGI), University of Girona, Girona, Spain
^j Department of Respiratory Medicine and French Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP, Paris, France
^k Institut Cochin, Université Paris Cité, INSERM U1016, Paris, France
^l Department of Medicine V, University Hospital, LMU Munich, Munich, Germany
^m Comprehensive Pneumology Center, German Center for Lung Research (DZL), Munich, Germany
ⁿ Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
^o University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
^p Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
^q Pulmonary Department, Division of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
^r Chronic Bronchial Infection Unit, Pneumology Service, Ramón y Cajal Hospital, Alcalá de Henares University, Madrid, Spain
^s Servicio de Neumología, Instituto Clínico de Respiratorio, Hospital Clínic Barcelona, August Pi Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
^t CIBERES, ISCIII, Madrid, Spain
^u Department of Respiratory Medicine, Erasmus MC, Rotterdam, The Netherlands
^v Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
^w Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
^x Clinic for Pulmonary Diseases, University Clinical Center of Serbia, Belgrade, Serbia
^y School of Medicine, University of Belgrade, Belgrade, Serbia
^z Pneumology Department, Hospital Universitario y Politécnico La Fe–Instituto de Investigación Sanitaria La Fe, Valencia, Spain
^aa Department of Respiratory Diseases, CHU de Toulouse, Toulouse, France
^bb Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
^cc Department of Pulmonology Diseases, Cerrahpasa Medical Faculty, İstanbul University–Cerrahpaşa, Istanbul, Turkey
^dd Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
^ee Institute for Pulmonary Diseases, Put doktora Goldmana 4, Sremska Kamenica, Serbia
^ff Department of Epidemiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
^gg Pulmonology Department, Centro Hospitalar Universitário São João and Faculty of Medicine, University of Porto, Porto, Portugal
^hh Department of Pulmonology, Hospital Clinic, University of Barcelona, CIBERES, IDIBAPS, ICREA, Barcelona, Spain
ⁱⁱ Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
^jj Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
^kk Biomedical Research in Endstage & Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
^ll European Reference Network on Rare and Complex Respiratory Diseases, Frankfurt, Germany
^mm Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
ⁿⁿ Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
^oo Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
^pp Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
^qq Department of Pulmonary Diseases, Amsterdam University Medical Centres, Amsterdam, The Netherlands
^rr Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel
^ss B. Rappaport Faculty of Medicine, The Technion, Israel Institute of Technology, Haifa, Israel
^tt Department of Pulmonary Diseases, Northwest Clinics, Alkmaar, The Netherlands
^uu Faculty of Medicine, Health and Life Sciences, Queen’s University, Belfast, Northern Ireland
^vv Respiratory Unit, IRCCS Humanitas Research Hospital, Milan, Italy
^ww Department of Biomedical Sciences, Humanitas University, Milan, Italy
^xx Department of Respiratory Disease, AZ Nikolaas, Sint-Niklaas, Belgium

^∗Corresponding author: James D. Chalmers, PhD, University of Dundee, Ninewells Hospital and Medical School, DD1 9SY Scotland, UK.University of DundeeNinewells Hospital and Medical SchoolDD1 9SYScotlandUK

Abstract

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.

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Key words : Asthma, registry, eosinophils, exacerbations

Abbreviations used : ABPA, BE+A, BSI, COPD, CT, EMBARC, ICS, IRR

Esquema

Methods

Data collection

Asthma diagnosis and related biomarkers

Long-term clinical outcomes

Statistical analysis

Results

Severity of disease in BE+A

ABPA and biologic data

Exacerbations

Long-term clinical outcomes

Discussion

Disclosure statement

Exportación

Vol 153 - N° 6

P. 1553-1562 - juin 2024 Regresar al número

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Bronchiectasis and asthma: Data from the European Bronchiectasis Registry (EMBARC) - 05/06/24

Abstract

Background

Objective

Methods

Results

Conclusions

Esquema

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