In 2017 EMBARC and BRR published a consensus definition of bronchiectasis exacerbation (BEX) for use in clinical studies. Validation in a real-world setting is needed.
The EMBARC exacerbation sub-study is a nested observational cohort within the larger EMBARC registry, enrolling patients during an exacerbation defined by clinicians? judgement. Patients were classified using BEX symptoms into two study groups: those consistent (A) or not consistent (B) with the EMBARC/BRR definition.
321 (62.6% female, median age 64) patients were enrolled from 15 different countries: 81% met the EMBARC/BRR definition (Group A). The most common symptoms of BEX in Group A were cough (96.2%), increased sputum volume (86.5%) and purulence (81.9%), while those in Group B had cough (42.6%), increased dyspnoea (34.4%) and fatigue (34.4%). Patients in Group A were significantly more severe than Group B in terms of BSI, FEV1 and daily sputum volume during stable state. A significantly different prevalence of BEX patients fulfilling the EMBARC/BRR definition was found when the population was stratified according to comorbid COPD and asthma (table).
| No COPD/asthma (139) | COPD (82) | COPD + asthma (16) | Asthma (84) | p | |
| EMBARC/BRR definition % | 84.2 | 86.6 | 75.0 | 71.4 | 0.047 |
| Female % | 76.3 | 30.5 | 43.8 | 75.0 | <0.001 |
| Median age | 60.0 | 68.5 | 71.5 | 61.5 | <0.001 |
| Median BSI | 7 | 11 | 8.5 | 8 | <0.001 |
Conclusion:Up to one fifth of BEX treated by clinicians in real-life cannot be detected using the EMBARC/BRR definition. The presence of asthma as a comorbidity is associated with different exacerbation symptoms.
Acknowledgments:EMBARC has received support from the EU/EFPIA Innovative Medicines Initiative Joint Undertaking iABC grant agreement no 115721