| Title: |
Symptoms, risk of future exacerbations, and response to long-term macrolide treatment in bronchiectasis: an observational study |
| Authors: |
Sibila O; Stobo J; Perea L; Gao Y-H; Xu J-F; Lind H; Viligorska K; Spinou A; Polverino E; Ringshausen FC; Vendrell M; Burgel P-R; 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 ED; Mendez R; 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 LD; Wong C; Terpstra L; Altenburg J; Boersma W; Chalmers JD |
| Source: |
The Lancet Respiratory Medicine, October 2025 |
| Publisher Information: |
Elsevier Ltd |
| Publication Year: |
2025 |
| Collection: |
Newcastle University Library ePrints Service |
| Description: |
© 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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 (60·9%) were female, and 3703 (39·1%) were male. The median Bronchiectasis Severity Index score was 7 (4–10) and Pseudomonas aeruginosa was present in the sputum of 2041 (21·6%) patients within 12-months of baseline. Previous exacerbations (rate ratio (RR) for every additional exacerbation 1·11, 95% CI 1·10–1·12; p |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
unknown |
| Relation: |
https://eprints.ncl.ac.uk/308067; https://eprints.ncl.ac.uk/fulltext.aspx?url=308067/45508D28-73F5-4B6E-BABF-A61AF0D19F2F.pdf&pub_id=308067 |
| Availability: |
https://eprints.ncl.ac.uk/308067 |
| Rights: |
https://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.9FAC270A |
| Database: |
BASE |