Bronchiectasis and asthma: data from the European Bronchiectasis Registry (EMBARC)

Eva Polverino; Katerina Dimakou; Letizia Traversi; Apostolos Bossios; Charles S. Haworth; Michael R. Loebinger; Anthony De Soyza; Montserrat Vendrell; Pierre-Régis Burgel; Pontus Mertsch; Melissa McDonnell; Sabina Škrgat; Luis M. Carro; Oriol Sibila; Menno van der Eerden; Paula Kauppi; Adam T. Hill; Robert Wilson; Branislava Milenkovic; Rosario Menendez; Marlene Murris; Tonia Digalaki; Megan L. Crichton; Sermin Borecki; Dusanka Obradovic; Adam Nowinski; Adelina Amorim; Antoni Torres; Natalie Lorent; Tobias Welte; Francesco Blasi; Eva Van Braeckel; Josje Altenburg; Amelia Shoemark; Michal Shteinberg; Wim Boersma; J. Stuart Elborn; Stefano Aliberti; Felix C. Ringshausen; James D. Chalmers; Pieter C. Goeminne; EMBARC Registry Investigators

doi:10.1016/j.jaci.2024.01.027

Bronchiectasis and asthma: data from the European Bronchiectasis Registry (EMBARC)

Eva Polverino, Katerina Dimakou, Letizia Traversi, Apostolos Bossios, Charles S. Haworth, Michael R. Loebinger, Anthony De Soyza, Montserrat Vendrell, Pierre-Régis Burgel, Pontus Mertsch, Melissa McDonnell, Sabina Škrgat, Luis M. Carro, Oriol Sibila, Menno van der Eerden, Paula Kauppi, Adam T. Hill, Robert Wilson, Branislava Milenkovic, Rosario MenendezMarlene Murris, Tonia Digalaki, Megan L. Crichton, Sermin Borecki, Dusanka Obradovic, Adam Nowinski, Adelina Amorim, Antoni Torres, Natalie Lorent, Tobias Welte, Francesco Blasi, Eva Van Braeckel, Josje Altenburg, Amelia Shoemark, Michal Shteinberg, Wim Boersma, J. Stuart Elborn, Stefano Aliberti, Felix C. Ringshausen, James D. Chalmers, Pieter C. Goeminne, EMBARC Registry Investigators

School of Medicine, Dentistry and Biomedical Sciences

Research output: Contribution to journal › Article › peer-review

15 Citations (Scopus)

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Abstract

Background
Asthma is commonly reported in patients with a diagnosis of bronchiectasis.

Objective
The aim of this study was to evaluate whether patients with bronchiectasis and asthma (BE+A) had a different clinical phenotype and different outcomes compared with patients with bronchiectasis without concomitant asthma.

Methods
A prospective observational pan-European registry (European Multicentre Bronchiectasis Audit and Research Collaboration) enrolled patients across 28 countries. Adult patients with computed tomography–confirmed bronchiectasis were reviewed at baseline and annual follow-up visits using an electronic case report form. Asthma was diagnosed by the local investigator. Follow-up data were used to explore differences in exacerbation frequency between groups using a negative binomial regression model. Survival analysis used Cox proportional hazards regression.

Results
Of 16,963 patients with bronchiectasis included for analysis, 5,267 (31.0%) had investigator-reported asthma. Patients with BE+A were younger, were more likely to be female and never smokers, and had a higher body mass index than patients with bronchiectasis without asthma. BE+A was associated with a higher prevalence of rhinosinusitis and nasal polyps as well as eosinophilia and Aspergillus sensitization. BE+A had similar microbiology but significantly lower severity of disease using the bronchiectasis severity index. Patients with BE+A were at increased risk of exacerbation after adjustment for disease severity and multiple confounders. Inhaled corticosteroid (ICS) use was associated with reduced mortality in patients with BE+A (adjusted hazard ratio 0.78, 95% CI 0.63-0.95) and reduced risk of hospitalization (rate ratio 0.67, 95% CI 0.67-0.86) compared with control subjects without asthma and not receiving ICSs.

Conclusions
BE+A was common and was associated with an increased risk of exacerbations and improved outcomes with ICS use. Unexpectedly we identified significantly lower mortality in patients with BE+A.

Original language	English
Pages (from-to)	1553-1562
Journal	Journal of Allergy and Clinical Immunology
Volume	153
Issue number	6
DOIs	https://doi.org/10.1016/j.jaci.2024.01.027
Publication status	Published - 05 Jun 2024

Keywords

asthma
registry
eosinophils
exacerbations

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10.1016/j.jaci.2024.01.027Licence: CC BY

Bronchiectasis and asthma: data from the European Bronchiectasis Registry (EMBARC)
Copyright 2024 The Authors. This is an open access article published under a Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium, provided the author and source are cited.
Final published version, 563 KBLicence: CC BY

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Polverino, E., Dimakou, K., Traversi, L., Bossios, A., Haworth, C. S., Loebinger, M. R., De Soyza, A., Vendrell, M., Burgel, P.-R., Mertsch, P., McDonnell, M., Škrgat, S., Carro, L. M., Sibila, O., van der Eerden, M., Kauppi, P., Hill, A. T., Wilson, R., Milenkovic, B., ... EMBARC Registry Investigators (2024). Bronchiectasis and asthma: data from the European Bronchiectasis Registry (EMBARC). Journal of Allergy and Clinical Immunology, 153(6), 1553-1562. https://doi.org/10.1016/j.jaci.2024.01.027

@article{3f88d91e5ce94dc596760256abc9cca4,

title = "Bronchiectasis and asthma: data from the European Bronchiectasis Registry (EMBARC)",

abstract = "BackgroundAsthma is commonly reported in patients with a diagnosis of bronchiectasis.ObjectiveThe aim of this study was to evaluate whether patients with bronchiectasis and asthma (BE+A) had a different clinical phenotype and different outcomes compared with patients with bronchiectasis without concomitant asthma.MethodsA prospective observational pan-European registry (European Multicentre Bronchiectasis Audit and Research Collaboration) enrolled patients across 28 countries. Adult patients with computed tomography–confirmed bronchiectasis were reviewed at baseline and annual follow-up visits using an electronic case report form. Asthma was diagnosed by the local investigator. Follow-up data were used to explore differences in exacerbation frequency between groups using a negative binomial regression model. Survival analysis used Cox proportional hazards regression.ResultsOf 16,963 patients with bronchiectasis included for analysis, 5,267 (31.0%) had investigator-reported asthma. Patients with BE+A were younger, were more likely to be female and never smokers, and had a higher body mass index than patients with bronchiectasis without asthma. BE+A was associated with a higher prevalence of rhinosinusitis and nasal polyps as well as eosinophilia and Aspergillus sensitization. BE+A had similar microbiology but significantly lower severity of disease using the bronchiectasis severity index. Patients with BE+A were at increased risk of exacerbation after adjustment for disease severity and multiple confounders. Inhaled corticosteroid (ICS) use was associated with reduced mortality in patients with BE+A (adjusted hazard ratio 0.78, 95% CI 0.63-0.95) and reduced risk of hospitalization (rate ratio 0.67, 95% CI 0.67-0.86) compared with control subjects without asthma and not receiving ICSs.ConclusionsBE+A was common and was associated with an increased risk of exacerbations and improved outcomes with ICS use. Unexpectedly we identified significantly lower mortality in patients with BE+A.",

keywords = "asthma, registry, eosinophils, exacerbations",

author = "Eva Polverino and Katerina Dimakou and Letizia Traversi and Apostolos Bossios and Haworth, {Charles S.} and Loebinger, {Michael R.} and {De Soyza}, Anthony and Montserrat Vendrell and Pierre-R{\'e}gis Burgel and Pontus Mertsch and Melissa McDonnell and Sabina {\v S}krgat and Carro, {Luis M.} and Oriol Sibila and {van der Eerden}, Menno and Paula Kauppi and Hill, {Adam T.} and Robert Wilson and Branislava Milenkovic and Rosario Menendez and Marlene Murris and Tonia Digalaki and Crichton, {Megan L.} and Sermin Borecki and Dusanka Obradovic and Adam Nowinski and Adelina Amorim and Antoni Torres and Natalie Lorent and Tobias Welte and Francesco Blasi and {Van Braeckel}, Eva and Josje Altenburg and Amelia Shoemark and Michal Shteinberg and Wim Boersma and Elborn, {J. Stuart} and Stefano Aliberti and Ringshausen, {Felix C.} and Chalmers, {James D.} and Goeminne, {Pieter C.} and {EMBARC Registry Investigators}",

year = "2024",

month = jun,

day = "5",

doi = "10.1016/j.jaci.2024.01.027",

language = "English",

volume = "153",

pages = "1553--1562",

journal = "Journal of Allergy and Clinical Immunology",

issn = "0091-6749",

publisher = "Elsevier Inc.",

number = "6",

}

Polverino, E, Dimakou, K, Traversi, L, Bossios, A, Haworth, CS, Loebinger, MR, De Soyza, A, Vendrell, M, Burgel, P-R, Mertsch, P, McDonnell, M, Škrgat, S, Carro, LM, Sibila, O, van der Eerden, M, Kauppi, P, Hill, AT, Wilson, R, Milenkovic, B, Menendez, R, Murris, M, Digalaki, T, Crichton, ML, Borecki, S, Obradovic, D, Nowinski, A, Amorim, A, Torres, A, Lorent, N, Welte, T, Blasi, F, Van Braeckel, E, Altenburg, J, Shoemark, A, Shteinberg, M, Boersma, W, Elborn, JS, Aliberti, S, Ringshausen, FC, Chalmers, JD, Goeminne, PC & EMBARC Registry Investigators 2024, 'Bronchiectasis and asthma: data from the European Bronchiectasis Registry (EMBARC)', Journal of Allergy and Clinical Immunology, vol. 153, no. 6, pp. 1553-1562. https://doi.org/10.1016/j.jaci.2024.01.027

TY - JOUR

T1 - Bronchiectasis and asthma: data from the European Bronchiectasis Registry (EMBARC)

AU - Polverino, Eva

AU - Dimakou, Katerina

AU - Traversi, Letizia

AU - Bossios, Apostolos

AU - Haworth, Charles S.

AU - Loebinger, Michael R.

AU - De Soyza, Anthony

AU - Vendrell, Montserrat

AU - Burgel, Pierre-Régis

AU - Mertsch, Pontus

AU - McDonnell, Melissa

AU - Škrgat, Sabina

AU - Carro, Luis M.

AU - Sibila, Oriol

AU - van der Eerden, Menno

AU - Kauppi, Paula

AU - Hill, Adam T.

AU - Wilson, Robert

AU - Milenkovic, Branislava

AU - Menendez, Rosario

AU - Murris, Marlene

AU - Digalaki, Tonia

AU - Crichton, Megan L.

AU - Borecki, Sermin

AU - Obradovic, Dusanka

AU - Nowinski, Adam

AU - Amorim, Adelina

AU - Torres, Antoni

AU - Lorent, Natalie

AU - Welte, Tobias

AU - Blasi, Francesco

AU - Van Braeckel, Eva

AU - Altenburg, Josje

AU - Shoemark, Amelia

AU - Shteinberg, Michal

AU - Boersma, Wim

AU - Elborn, J. Stuart

AU - Aliberti, Stefano

AU - Ringshausen, Felix C.

AU - Chalmers, James D.

AU - Goeminne, Pieter C.

AU - EMBARC Registry Investigators

PY - 2024/6/5

Y1 - 2024/6/5

N2 - BackgroundAsthma is commonly reported in patients with a diagnosis of bronchiectasis.ObjectiveThe aim of this study was to evaluate whether patients with bronchiectasis and asthma (BE+A) had a different clinical phenotype and different outcomes compared with patients with bronchiectasis without concomitant asthma.MethodsA prospective observational pan-European registry (European Multicentre Bronchiectasis Audit and Research Collaboration) enrolled patients across 28 countries. Adult patients with computed tomography–confirmed bronchiectasis were reviewed at baseline and annual follow-up visits using an electronic case report form. Asthma was diagnosed by the local investigator. Follow-up data were used to explore differences in exacerbation frequency between groups using a negative binomial regression model. Survival analysis used Cox proportional hazards regression.ResultsOf 16,963 patients with bronchiectasis included for analysis, 5,267 (31.0%) had investigator-reported asthma. Patients with BE+A were younger, were more likely to be female and never smokers, and had a higher body mass index than patients with bronchiectasis without asthma. BE+A was associated with a higher prevalence of rhinosinusitis and nasal polyps as well as eosinophilia and Aspergillus sensitization. BE+A had similar microbiology but significantly lower severity of disease using the bronchiectasis severity index. Patients with BE+A were at increased risk of exacerbation after adjustment for disease severity and multiple confounders. Inhaled corticosteroid (ICS) use was associated with reduced mortality in patients with BE+A (adjusted hazard ratio 0.78, 95% CI 0.63-0.95) and reduced risk of hospitalization (rate ratio 0.67, 95% CI 0.67-0.86) compared with control subjects without asthma and not receiving ICSs.ConclusionsBE+A was common and was associated with an increased risk of exacerbations and improved outcomes with ICS use. Unexpectedly we identified significantly lower mortality in patients with BE+A.

AB - BackgroundAsthma is commonly reported in patients with a diagnosis of bronchiectasis.ObjectiveThe aim of this study was to evaluate whether patients with bronchiectasis and asthma (BE+A) had a different clinical phenotype and different outcomes compared with patients with bronchiectasis without concomitant asthma.MethodsA prospective observational pan-European registry (European Multicentre Bronchiectasis Audit and Research Collaboration) enrolled patients across 28 countries. Adult patients with computed tomography–confirmed bronchiectasis were reviewed at baseline and annual follow-up visits using an electronic case report form. Asthma was diagnosed by the local investigator. Follow-up data were used to explore differences in exacerbation frequency between groups using a negative binomial regression model. Survival analysis used Cox proportional hazards regression.ResultsOf 16,963 patients with bronchiectasis included for analysis, 5,267 (31.0%) had investigator-reported asthma. Patients with BE+A were younger, were more likely to be female and never smokers, and had a higher body mass index than patients with bronchiectasis without asthma. BE+A was associated with a higher prevalence of rhinosinusitis and nasal polyps as well as eosinophilia and Aspergillus sensitization. BE+A had similar microbiology but significantly lower severity of disease using the bronchiectasis severity index. Patients with BE+A were at increased risk of exacerbation after adjustment for disease severity and multiple confounders. Inhaled corticosteroid (ICS) use was associated with reduced mortality in patients with BE+A (adjusted hazard ratio 0.78, 95% CI 0.63-0.95) and reduced risk of hospitalization (rate ratio 0.67, 95% CI 0.67-0.86) compared with control subjects without asthma and not receiving ICSs.ConclusionsBE+A was common and was associated with an increased risk of exacerbations and improved outcomes with ICS use. Unexpectedly we identified significantly lower mortality in patients with BE+A.

KW - asthma

KW - registry

KW - eosinophils

KW - exacerbations

U2 - 10.1016/j.jaci.2024.01.027

DO - 10.1016/j.jaci.2024.01.027

M3 - Article

C2 - 38401857

SN - 0091-6749

VL - 153

SP - 1553

EP - 1562

JO - Journal of Allergy and Clinical Immunology

JF - Journal of Allergy and Clinical Immunology

IS - 6

ER -

Bronchiectasis and asthma: data from the European Bronchiectasis Registry (EMBARC)

Abstract

Keywords

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