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

Eva Polverino¹, Katerina Dimakou², Letizia Traversi¹, Apostolos Bossios³, Charles S Haworth⁴, Michael R Loebinger⁵, Anthony De Soyza⁶, Montserrat Vendrell⁷, Pierre-Régis Burgel⁸, Pontus Mertsch⁹, Melissa McDonnell¹⁰, Sabina Škrgat¹¹, Luis Maiz Carro¹², Oriol Sibila¹³, Menno van der Eerden¹⁴, Paula Kauppi¹⁵, Adam T Hill¹⁶, Robert Wilson⁴, Branislava Milenkovic¹⁷, Rosario Menendez¹⁸, Marlene Murris¹⁹, Tonia Digalaki², Megan L Crichton²⁰, Sermin Borecki²¹, Dusanka Obradovic²², Adam Nowinski²³, Adelina Amorim²⁴, Antoni Torres²⁵, Natalie Lorent²⁶, Tobias Welte²⁷, Francesco Blasi²⁸, Eva Van Braeckel²⁹, Josje Altenburg³⁰, Amelia Shoemark²⁰, Michal Shteinberg³¹, Wim Boersma³², J Stuart Elborn³³, Stefano Aliberti³⁴, Felix C Ringshausen²⁷, James D Chalmers³⁵, Pieter C Goeminne³⁶; EMBARC registry investigators

Affiliations

¹ Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, CIBERES, Barcelona, Spain.
² Fifth Respiratory Department and Bronchiectasis Unit, General Hospital for Chest Diseases "Sotiria," Athens, Greece.
³ Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden; Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
⁴ Cambridge Centre for Lung Infection, Royal Papworth Hospital and University of Cambridge, Cambridge, United Kingdom.
⁵ National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College London, London, United Kingdom.
⁶ Population and Health Science Institute, Newcastle University, Newcastle, United Kingdom; NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle, United Kingdom.
⁷ Department of Pulmonology, Girona Biomedical Research Institute Dr Josep Trueta University Hospital (IDIBGI), University of Girona, Girona, Spain.
⁸ Department of Medicine V, University Hospital, LMU Munich, Munich, Germany; Department of Respiratory Medicine and French Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP, Paris, France; Institut Cochin, Université Paris Cité, INSERM U1016, Paris, France.
⁹ Department of Medicine V, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center, German Center for Lung Research (DZL), Munich, Germany.
¹⁰ Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland.
¹¹ University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia; Pulmonary Department, Division of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia.
¹² Chronic Bronchial Infection Unit, Pneumology Service, Ramón y Cajal Hospital, Alcalá de Henares University, Madrid, Spain.
¹³ Servicio de Neumología, Instituto Clínico de Respiratorio, Hospital Clínic Barcelona, August Pi Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain; CIBERES, ISCIII, Madrid, Spain.
¹⁴ Department of Respiratory Medicine, Erasmus MC, Rotterdam, The Netherlands.
¹⁵ Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
¹⁶ Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
¹⁷ Clinic for Pulmonary Diseases, University Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia.
¹⁸ Pneumology Department, Hospital Universitario y Politécnico La Fe-Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
¹⁹ Department of Respiratory Diseases, CHU de Toulouse, Toulouse, France.
²⁰ Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom.
²¹ Department of Pulmonology Diseases, Cerrahpasa Medical Faculty, İstanbul University-Cerrahpaşa, Istanbul, Turkey.
²² Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia; Institute for Pulmonary Diseases, Put doktora Goldmana 4, Sremska Kamenica, Serbia.
²³ Department of Epidemiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.
²⁴ Pulmonology Department, Centro Hospitalar Universitário São João and Faculty of Medicine, University of Porto, Porto, Portugal.
²⁵ Department of Pulmonology, Hospital Clinic, University of Barcelona, CIBERES, IDIBAPS, ICREA, Barcelona, Spain.
²⁶ Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.
²⁷ Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage & Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; European Reference Network on Rare and Complex Respiratory Diseases, Frankfurt, Germany.
²⁸ Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
²⁹ Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
³⁰ Department of Pulmonary Diseases, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
³¹ Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel; B. Rappaport Faculty of Medicine, The Technion, Israel Institute of Technology, Haifa, Israel.
³² Department of Pulmonary Diseases, Northwest Clinics, Alkmaar, The Netherlands.
³³ Faculty of Medicine, Health and Life Sciences, Queen's University, Belfast, Northern Ireland.
³⁴ Respiratory Unit, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
³⁵ Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom. Electronic address: j.chalmers@dundee.ac.uk.
³⁶ Department of Respiratory Disease, AZ Nikolaas, Sint-Niklaas, Belgium.

PMID: 38401857
DOI: 10.1016/j.jaci.2024.01.027

Free article

Observational Study

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

Eva Polverino et al. J Allergy Clin Immunol. 2024 Jun.

Free article

. 2024 Jun;153(6):1553-1562.

doi: 10.1016/j.jaci.2024.01.027. Epub 2024 Feb 23.

Authors

Affiliations

¹ Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, CIBERES, Barcelona, Spain.
² Fifth Respiratory Department and Bronchiectasis Unit, General Hospital for Chest Diseases "Sotiria," Athens, Greece.
³ Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden; Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
⁴ Cambridge Centre for Lung Infection, Royal Papworth Hospital and University of Cambridge, Cambridge, United Kingdom.
⁵ National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College London, London, United Kingdom.
⁶ Population and Health Science Institute, Newcastle University, Newcastle, United Kingdom; NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle, United Kingdom.
⁷ Department of Pulmonology, Girona Biomedical Research Institute Dr Josep Trueta University Hospital (IDIBGI), University of Girona, Girona, Spain.
⁸ Department of Medicine V, University Hospital, LMU Munich, Munich, Germany; Department of Respiratory Medicine and French Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP, Paris, France; Institut Cochin, Université Paris Cité, INSERM U1016, Paris, France.
⁹ Department of Medicine V, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center, German Center for Lung Research (DZL), Munich, Germany.
¹⁰ Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland.
¹¹ University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia; Pulmonary Department, Division of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia.
¹² Chronic Bronchial Infection Unit, Pneumology Service, Ramón y Cajal Hospital, Alcalá de Henares University, Madrid, Spain.
¹³ Servicio de Neumología, Instituto Clínico de Respiratorio, Hospital Clínic Barcelona, August Pi Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain; CIBERES, ISCIII, Madrid, Spain.
¹⁴ Department of Respiratory Medicine, Erasmus MC, Rotterdam, The Netherlands.
¹⁵ Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
¹⁶ Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
¹⁷ Clinic for Pulmonary Diseases, University Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia.
¹⁸ Pneumology Department, Hospital Universitario y Politécnico La Fe-Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
¹⁹ Department of Respiratory Diseases, CHU de Toulouse, Toulouse, France.
²⁰ Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom.
²¹ Department of Pulmonology Diseases, Cerrahpasa Medical Faculty, İstanbul University-Cerrahpaşa, Istanbul, Turkey.
²² Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia; Institute for Pulmonary Diseases, Put doktora Goldmana 4, Sremska Kamenica, Serbia.
²³ Department of Epidemiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.
²⁴ Pulmonology Department, Centro Hospitalar Universitário São João and Faculty of Medicine, University of Porto, Porto, Portugal.
²⁵ Department of Pulmonology, Hospital Clinic, University of Barcelona, CIBERES, IDIBAPS, ICREA, Barcelona, Spain.
²⁶ Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.
²⁷ Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage & Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; European Reference Network on Rare and Complex Respiratory Diseases, Frankfurt, Germany.
²⁸ Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
²⁹ Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
³⁰ Department of Pulmonary Diseases, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
³¹ Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel; B. Rappaport Faculty of Medicine, The Technion, Israel Institute of Technology, Haifa, Israel.
³² Department of Pulmonary Diseases, Northwest Clinics, Alkmaar, The Netherlands.
³³ Faculty of Medicine, Health and Life Sciences, Queen's University, Belfast, Northern Ireland.
³⁴ Respiratory Unit, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
³⁵ Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom. Electronic address: j.chalmers@dundee.ac.uk.
³⁶ Department of Respiratory Disease, AZ Nikolaas, Sint-Niklaas, Belgium.

PMID: 38401857
DOI: 10.1016/j.jaci.2024.01.027

Erratum in

Corrigendum.
[No authors listed] [No authors listed] J Allergy Clin Immunol. 2024 Oct;154(4):1078. doi: 10.1016/j.jaci.2024.07.010. J Allergy Clin Immunol. 2024. PMID: 39368827 No abstract available.

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.

Keywords: Asthma; eosinophils; exacerbations; registry.

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

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

Authors

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Medical