Symptoms, risk of future exacerbations, and response to long-term macrolide treatment in bronchiectasis: an observational study
Bronchiectasis symptoms as predictors of future exacerbations
Previous studies have suggested that daily symptoms are a marker of bronchiectasis disease activity and could therefore identify patients at increased risk of exacerbation.
This study aimed if symptoms independently predict future exacerbations and therefore identify additional responders to long-term macrolide treatment.
Study design and methods: evaluating bronchiectasis symptoms
Data were obtained from the EMBARC registry.
Baseline symptoms were evaluated using the quality-of-life bronchiectasis questionnaire respiratory symptoms score (QoL-B-RSS), followed-up for at least 1 year, and related to the future risk of exacerbations.
A post-hoc pooled analysis was conducted in 341 participantswith bronchiectasis to determine if baseline symptoms were associated with response to long-term macrolide treatment, using a negative binomial regression model.
Key findings: bronchiectasis symptoms independently predict exacerbation risk
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, and 60.9% were female.
Previous exacerbations (rate ratio (RR) for every additional exacerbation 1·11, 95% CI 1·10–1·12; p<0·0001) and symptoms (RR for every 10 points lower QoL-B-RSS 1·10, 1·09–1·11; p<0·0001) 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 and the group with no previous exacerbations but high symptom scores.
Macrolide therapy benefits in symptomatic patients
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 (NNT) to prevent exacerbations with long-term macrolide therapy was similar in patients selected based on frequent exacerbations and in those with few exacerbations but high symptom scores.
Clinical implications for bronchiectasis management
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.
Authors
Oriol Sibila, Jamie Stobo, Lidia Perea, Yong-Hua Gao, Jin-Fu Xu, Holly Lind, Kateryna Viligorska, Arietta Spinou, Eva Polverino, Felix C Ringshausen, Montserrat Vendrell, Pierre-Régis Burgel, Charles S Haworth, Michael R Loebinger, Natalie Lorent, Raja Dhar, Hayoung Choi, Sanjay H Chotirmall, Anthony De Soyza, John R Hurst, Jeremy S Brown, Menno van der Eerden, Paula Kauppi, Emma D Johnson, Raul Mendez, Katerina Dimakou, Apostolos Bossios, Antoni Torres, Francesco Blasi, Michal Shteinberg, Stuart J Elborn, Pieter C Goeminne, Stefano Aliberti, Lata Jayaram, Noel Karalus, Steven L Taylor, Megan L Martin, Lucy D Burr, Conroy Wong, Lotte Terpstra, Josje Altenburg, Wim Boersma, James D Chalmers.
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Fecha de publicación
Published Online: August 27, 2025
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