Bronchiectasis and asthma: Data from The European Bronchiectasis Registry (EMBARC).

asthma eosinophils exacerbations registry

Journal

The Journal of allergy and clinical immunology
ISSN: 1097-6825
Titre abrégé: J Allergy Clin Immunol
Pays: United States
ID NLM: 1275002

Informations de publication

Date de publication:
22 Feb 2024
Historique:
received: 14 09 2023
revised: 15 12 2023
accepted: 18 01 2024
medline: 25 2 2024
pubmed: 25 2 2024
entrez: 24 2 2024
Statut: aheadofprint

Résumé

Asthma is commonly reported in patients with a diagnosis of bronchiectasis. The aim of this study was to evaluate if patients with asthma and bronchiectasis had a different clinical phenotype and different outcomes compared to patients with bronchiectasis without concomitant asthma. Prospective observational pan-European registry (EMBARC) enrolling patients across 28 countries. Adult patients with CT 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 utilised Cox-proportional hazards regression. 16963 patients with bronchiectasis were included for analysis. 5267 patients (31.0%) had investigator reported asthma. Patients with bronchiectasis and asthma (BE+A) were younger, more likely to be female and never smokers, and had a higher BMI 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 (BSI). The BE+A group were at increased risk of exacerbation after adjustment for severity of disease and multiple confounders. Inhaled corticosteroid use was associated with reduced mortality in BE+A patients (adjusted hazard ratio 0.78 (0.63-0.95)) and reduced risk of hospitalization, (rate ratio 0.67 (0.67-0.86)) compared to a control population without asthma and not receiving inhaled corticosteroid. Combined bronchiectasis and asthma was common and was associated with an increased risk of exacerbations and improved outcomes with inhaled corticosteroid use. Unexpectedly we identified significantly lower mortality in patients with bronchiectasis and asthma.

Sections du résumé

BACKGROUND BACKGROUND
Asthma is commonly reported in patients with a diagnosis of bronchiectasis.
OBJECTIVE OBJECTIVE
The aim of this study was to evaluate if patients with asthma and bronchiectasis had a different clinical phenotype and different outcomes compared to patients with bronchiectasis without concomitant asthma.
METHODS METHODS
Prospective observational pan-European registry (EMBARC) enrolling patients across 28 countries. Adult patients with CT 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 utilised Cox-proportional hazards regression.
RESULTS RESULTS
16963 patients with bronchiectasis were included for analysis. 5267 patients (31.0%) had investigator reported asthma. Patients with bronchiectasis and asthma (BE+A) were younger, more likely to be female and never smokers, and had a higher BMI 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 (BSI). The BE+A group were at increased risk of exacerbation after adjustment for severity of disease and multiple confounders. Inhaled corticosteroid use was associated with reduced mortality in BE+A patients (adjusted hazard ratio 0.78 (0.63-0.95)) and reduced risk of hospitalization, (rate ratio 0.67 (0.67-0.86)) compared to a control population without asthma and not receiving inhaled corticosteroid.
CONCLUSION CONCLUSIONS
Combined bronchiectasis and asthma was common and was associated with an increased risk of exacerbations and improved outcomes with inhaled corticosteroid use. Unexpectedly we identified significantly lower mortality in patients with bronchiectasis and asthma.

Identifiants

DOI: 10.1016/j.jaci.2024.01.027 PMID: 38401857
pubmed: 38401857
pii: S0091-6749(24)00189-1
doi: 10.1016/j.jaci.2024.01.027
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Auteurs

Eva Polverino (E)

Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBERES, Barcelona, Spain.

Katerina Dimakou (K)

5(th) Respiratory Department and Bronchiectasis Unit, ''SOTIRIA" General Hospital of Chest Diseases Medical Practice: 86 Kifisias Ave, Ampelokipi, Athens, Greece.

Letizia Traversi (L)

Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBERES, Barcelona, Spain.

Apostolos Bossios (A)

Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden; Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.

Charles S Haworth (CS)

Cambridge Centre for Lung Infection, Royal Papworth Hospital and University of Cambridge, Cambridge, UK.

Michael R Loebinger (MR)

Royal Brompton and Harefield Hospitals and National Heart and Lung Institute, Imperial College London, UK.

Anthony De Soyza (A)

Population and Health Science Institute, Newcastle University and NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle, UK.

Montserrat Vendrell (M)

Department of Pulmonology, Dr Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Spain.

Pierre-Régis Burgel (PR)

Department of Respiratory Medicine and French Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP; Université Paris Cité, Inserm U1016, Institut Cochin, Paris, France.

Pontus Mertsch (P)

Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany.

Melissa McDonnell (M)

Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland.

Sabina Škrgat (S)

University Clinic of Respiratory and Allergic Diseases Golnik, Golnik 36, 4204, Golnik, Slovenia, Medical Faculty, University of Ljubljana, Korytkova ulica 2, 1000, Ljubljana, Slovenia; University Medical Centre Ljubljana, Division of Internal Medicine, Pulmonary Department, Zaloška cesta 7, 1000, Ljubljana, Slovenia.

Luis M Carro (LM)

Chronic Bronchial Infection Unit, Pneumology Service, Ramón y Cajal Hospital, Alcalá de Henares University, Madrid, Spain.

Oriol Sibila (O)

Servicio de Neumología, Instituto Clínico de Respiratorio. IDIBAPS. Hospital Clínic, University of Barcelona, Spain; CIBER de enfermedades respiratorias, ISCIII, Madrid, Spain.

Menno van der Eerden (M)

Erasmus MC, department of respiratory medicine, Rotterdam, The Netherlands.

Paula Kauppi (P)

Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Adam T Hill (AT)

Royal Infirmary of Edinburgh, Department of Respiratory Medicine, Edinburgh, Edinburgh, UK.

Robert Wilson (R)

Cambridge Centre for Lung Infection, Royal Papworth Hospital and University of Cambridge, Cambridge, UK.

Branislava Milenkovic (B)

Clinic for Pulmonary Diseases, University Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Serbia.

Rosario Menendez (R)

Pneumology Department, Hospital Universitario y Politécnico La Fe-Instituto de Investigación Sanitaria La Fe, Valencia, Spain.

Marlene Murris (M)

Department of Respiratory Diseases, CHU Toulouse, Toulouse, France.

Tonia Digalaki (T)

5(th) Respiratory Department and Bronchiectasis Unit, ''SOTIRIA" General Hospital of Chest Diseases Medical Practice: 86 Kifisias Ave, Ampelokipi, Athens, Greece.

Megan L Crichton (ML)

Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.

Sermin Borecki (S)

Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Pulmonology Diseases, Istanbul, Turkey.

Dusanka Obradovic (D)

Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia, Institute for pulmonary diseases, Put Doktora Goldmana 4, Sremska Kamenica, Serbia.

Adam Nowinski (A)

Department of Epidemiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.

Adelina Amorim (A)

Pulmonology Department - Centro Hospitalar Universitário S.João and Faculty of Medicine - University of Porto, Portugal.

Antoni Torres (A)

Department of Pulmonology Hospital Clinic of Barcelona, Spain University of Barcelona, CIBERES, IDIBAPS, ICREA Barcelona, Spain.

Natalie Lorent (N)

Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.

Tobias Welte (T)

Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; European Reference Network on Rare and Complex Respiratory Diseases, Frankfurt, Germany.

Francesco Blasi (F)

Department of Pathophysiology and Transplantation, University of Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Eva Van Braeckel (E)

Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.

Josje Altenburg (J)

Amsterdam University Medical Centres, Amsterdam, the Netherlands; Department of Pulmonary diseases, Amsterdam University Medical Centres, Amsterdam, the Netherlands.

Amelia Shoemark (A)

Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.

Michal Shteinberg (M)

Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel; The Technion, Israel Institute of Technology, the B. Rappaport Faculty of Medicine, Haifa, Israel.

Wim Boersma (W)

Department of Pulmonary Diseases, Northwest Clinics, Alkmaar, Netherlands.

J Stuart Elborn (JS)

Faculty of Medicine, Health and Life Sciences, Queen's University, Belfast, UK.

Stefano Aliberti (S)

IRCCS Humanitas Research Hospital, Respiratory Unit, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.

Felix C Ringshausen (FC)

Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; European Reference Network on Rare and Complex Respiratory Diseases, Frankfurt, Germany.

James D Chalmers (JD)

Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK. Electronic address: j.chalmers@dundee.ac.uk.

Pieter C Goeminne (PC)

Department of Respiratory Disease, AZ Nikolaas, Belgium.

Classifications MeSH