Introduction: EMBARC India registry showed dramatic underuse of nebulized antibiotics in Indian clinical settings. QUONAB survey aimed to understand the usage pattern of nebulized antibiotics and thereby improve management of Bronchiectasis patients.

Method: A digital questionnaire with (19 questions) was given to doctors across India for their participation.

Results: 876 physicians participated in survey. Nebulized antibiotics were prescribed at home by 83.7% of doctors, among which 63.9% prescribe Tobramycin, 7.3% Colistin, and 24.6% preferred both in treatment of Bronchiectasis. Predominantly nebulized antibiotics were not prescribed because of cost (39.1%) followed by fear of side effects or lack of efficacy, limited access, or cost of mesh nebulizer. Major side effects which concerned doctors included bronchospasm, antibiotic resistance, and systemic adverse effects. Nebulized antibiotics were prescribed for recurrent exacerbations, persistent bacterial colonization, and acute exacerbation. 75% of doctors prescribed home nebulized antibiotics for duration of 2 weeks to 3 months. However, reason to stop early (<3 month) was cost (28.7%), no longer needed (11.3%) or sputum culture negative (8.4%). Jet nebulizer was preferred by 53.2% of doctors, followed by mesh nebulizer (34.5%). Interestingly, 96% of doctors were keen to increase use of nebulized antibiotics for right indications.

Conclusion: QUONAB survey highlights the need for creating awareness on appropriate use of home nebulized antibiotics in India. Major concerns of the physicians which need to be addressed are high cost, uncertainty of efficacy, side effects and accessibility of mesh nebulizers.