Symptoms, risk of future exacerbations, and response to long-term macrolide treatment in bronchiectasis: an observational study

作者：Oriol Sibila, Jamie Stobo, Lídia Perea, Yong‐hua Gao, Jin‐Fu Xu, Holly Lind, Kateryna Viligorska, Arietta Spinou, Eva Polverino, Felix C. Ringshausen, Montserrat Vendrell, Pierre‐Régis Burgel, Charles Haworth, Michael R. Loebinger, Natalie Lorent, Raja Dhar, Hayoung Choi, Sanjay H. Chotirmall, Anthony De Soyza, John R. Hurst, Jeremy Brown, Menno M. van der Eerden, Paula Kauppi, Emma D Johnson, Raúl Méndez, Katerina Dimakou, Apostolos Bossios, Antoni Torres, Francesco Blasi, Michal Shteinberg, J.S. Elborn, Pieter Goeminne, Stefano Aliberti, Lata Jayaram, Noel Karalus, Steven Taylor, Megan Martin, Lucy Burr, Conroy Wong, Lotte Terpstra, Josje Altenburg, Wim Boersma, James D Chalmers · 发表于：The Lancet Respiratory Medicine · 年份：2025 · DOI：10.1016/s2213-2600(25)00160-2 · 被引用次数：26 · 研究领域：Cystic Fibrosis Research Advances、Chronic Obstructive Pulmonary Disease (COPD) Research、Respiratory and Cough-Related Research

BACKGROUND: 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%) pa...