ERS guidelines suggest the use of long-acting bronchodilators in bronchiectasis people with significant breathlessness or airway obstruction.

To provide a real-world overview of bronchodilator prescription, a secondary analysis of EMBARC, a prospective observational study enrolling adults with bronchiectasis from Europe and Israel, has been conducted.

Out of 16,963 patients with bronchiectasis, 8,632 (50.9%) were using long-acting beta agonists (LABA) and 4,707 (27.2%) were using long-acting muscarinic antagonists (LAMA) at baseline. 9,677 (57.0%) were using at least one bronchodilator, and two bronchodilators, with or without an inhaled corticosteroid (ICS) were used by 3,764 (22.2%). When stratified by the severity of breathlessness measured by the mMRC scale or lung function, there was a clear increase in bronchodilator use in people with more severe breathlessness and airflow obstruction (both P < 0.0001). Nevertheless, ¼ of patients with mMRC score 4 were not receiving any bronchodilator treatment, and 1 in 5 patients with FEV1 < 30% predicted were not treated with bronchodilators. Most patients with severe breathlessness and low lung function were not receiving dual bronchodilator treatment.

Our data suggest poor adherence to ERS guidelines on bronchodilator prescription.