Bronchiectasis, a progressive respiratory condition, poses a significant challenge to patients, healthcare systems, and quality of life. This article delves into the findings presented at the European Respiratory Society (ERS) Congress in Amsterdam, highlighting the real-world impact of bronchiectasis across the UK, France, and Japan. The burden of bronchiectasis exacerbations is a critical issue that demands our attention and action.
Meeting Summary:
Three esteemed respiratory experts, Professor Michael R. Loebinger from Imperial College London, Professor Pierre-Régis Burgel from Hôpital Cochin AP-HP, and Assistant Professor Takanori Asakura from Keio University School of Medicine, shared their insights at the ERS Congress. They presented real-world data, offering a unique perspective on the clinical characteristics, treatment patterns, and exacerbations of bronchiectasis patients in their respective countries.
Overall Summary:
The studies conducted in the UK, France, and Japan provide a comprehensive view of bronchiectasis's impact. Patients with multiple exacerbations during the baseline period were more likely to have comorbidities like asthma and COPD, and they carried a heavier treatment burden. The presence of these comorbidities and frequent exacerbations was associated with an increased risk of further exacerbations during follow-up. This trend was observed consistently across all three countries, emphasizing the urgent need for effective management strategies.
Background:
Bronchiectasis is a chronic, inflammatory respiratory condition characterized by a permanent dilation of the bronchi. It often presents with persistent cough, sputum production, and exacerbations, which require antibiotic therapy or hospitalization, thus contributing to the disease's substantial burden. The updated ERS guidelines identify patients at high risk of exacerbations based on their history of exacerbations and daily symptom severity.
Existing evidence from the USA and Europe highlights the significant morbidity associated with bronchiectasis exacerbations, including increased hospitalization rates and impaired quality of life. However, there has been a lack of research specifically examining morbidity and treatment patterns related to bronchiectasis exacerbations in the UK, France, and Japan.
Morbidity and Treatment Patterns in the UK and France:
Two studies focused on the association of exacerbations with morbidity and treatment patterns among bronchiectasis patients in the UK and France. These studies utilized primary care electronic health record (EHR) data to gain insights into patient demographics, comorbidities, and treatment patterns.
Methodology:
The studies employed retrospective designs, analyzing data from 2018 to the end of 2022 via The Health Improvement Network (THIN) in the UK and France. Eligible participants were individuals aged 12 years or older diagnosed with bronchiectasis in 2018, excluding those with cystic fibrosis.
Clinical Characteristics:
A total of 12,106 patients were included in the UK study, and 6,194 in France. Notably, 15.5% of UK patients and 12.5% of French patients experienced two or more exacerbations during the baseline period. These patients were significantly more likely to have comorbidities such as asthma, COPD, gastro-oesophageal reflux disease, and heart failure compared to those with fewer exacerbations.
Exacerbation Risk Factors:
Approximately 70% of UK patients and 75% of French patients with two or more exacerbations during the baseline period experienced a subsequent exacerbation within the first year of follow-up. This is in contrast to only around 30% and 25% of patients in the UK and France, respectively, who had fewer than two exacerbations during baseline.
After adjusting for covariates, the presence of two or more exacerbations during the baseline period was associated with a 160% increased risk of further exacerbations in the UK and a 309% increased risk in France. Additionally, the presence of COPD and asthma in the UK, and COPD and heart failure in France, further increased the risk of subsequent exacerbations.
Treatment Patterns:
In both the UK and France, patients with two or more exacerbations during the baseline period were more likely to have received treatments such as antibiotics (oral and inhaled), inhaled corticosteroids, oral steroids, mucolytics, and bronchodilators, either at baseline or during follow-up, compared to those with fewer exacerbations. The use of long-term antibiotics remained relatively stable over time among patients with frequent exacerbations in both countries.
Limitations:
Several limitations should be considered when interpreting these findings. The definition of exacerbations used in the studies may have led to an underestimation of the actual exacerbation frequency, as self-managed episodes were unlikely to be captured in EHRs. Additionally, the data were derived exclusively from primary care sites, and exacerbations or treatments managed in hospital settings may not have been fully represented. Finally, the COVID-19 pandemic and patient loss during follow-up may have influenced treatment patterns.
Conclusion:
Data from the THIN UK and France databases indicate that patients with bronchiectasis who experienced two or more exacerbations during the baseline period were at the highest risk of further exacerbations during follow-up. These patients also had more comorbidities and a higher overall treatment burden. Effective strategies to reduce and manage exacerbations are crucial to alleviate the overall burden of bronchiectasis.
Exacerbations in Japan:
This study focused on evaluating bronchiectasis-associated exacerbations among incident cases and in subgroups of patients with preexisting respiratory diseases in Japan.
Methodology:
The study utilized two administrative claims databases provided by JMDC, Inc., including insured individuals aged under 75 years from February 2015 to April 2023, and those aged 75 years or older from April 2019 to March 2023.
Patients with bronchiectasis were identified based on claims-based diagnostic criteria. Incident cases were defined as meeting bronchiectasis diagnosis criteria without any other bronchiectasis-related claim in the year prior to the index date.
Study outcomes included pulmonary exacerbations, defined as bronchiectasis-related hospitalization or ambulatory visits followed by oral or intravenous (IV) antibiotic administration. Exacerbations were categorized based on the need for oral antibiotics or hospitalization/IV antibiotics.
Results:
A total of 6,288 patients aged under 75 years and 1,127 patients aged 75 years or older were included in the analysis. Compared to those under 75 years, a higher proportion of patients aged 75 years or older had all-cause hospitalizations, respiratory-related hospitalizations, and long-term macrolide use during the year prior to their non-cystic fibrosis bronchiectasis diagnosis.
During the follow-up period, 63.6% of patients aged under 75 years (mean follow-up of 2.8 years) and 67.2% of patients aged 75 years or older (mean follow-up of 1.4 years) experienced at least one exacerbation. The proportion of patients requiring hospitalization or IV antibiotics for an exacerbation was approximately three times higher in the older age group compared to the younger group (67.6% vs. 23.0%). The annualized rate of exacerbations requiring hospitalization or IV antibiotics was around six times higher among patients aged 75 years or older than among those under 75 years (0.43 vs. 0.07 per person-year).
Patients with preexisting respiratory diseases (COPD, asthma, nontuberculous mycobacterial pulmonary disease, or chronic rhinosinusitis) presented with higher proportions of patients with exacerbations, higher annualized rates, and a shorter time to the first exacerbation, indicating a greater burden of exacerbations. These trends were generally consistent across both age cohorts in the four subpopulations.
Limitations:
The study has several limitations. Underreporting of pulmonary exacerbations may occur due to the absence of claims with bronchiectasis International Classification of Diseases (ICD) codes. The inclusion criteria for incident cases may have resulted in the inclusion of prevalent cases with earlier diagnoses, while patients with shorter disease histories may have experienced fewer exacerbations, potentially underestimating the overall exacerbation burden. Additionally, the study period coincided with the COVID-19 pandemic, which may have contributed to underreporting of bronchiectasis-related hospitalisations.
Conclusion:
This large-scale, real-world, population-based study is the first of its kind to analyze exacerbations among incident patients with bronchiectasis across all age populations in Japan. The findings reveal a substantial burden of exacerbations, regardless of patient age or the presence of preexisting respiratory diseases. These results emphasize the urgent need for effective management strategies to reduce or prevent exacerbations and alleviate the overall burden of bronchiectasis in Japan.
MED-ALL-BE-00048 October 2025
