Clinical outcomes of bronchiectasis in India: data from the EMBARC/Respiratory Research Network of India registry

Dhar, Raja; Singh, Sheetu; Talwar, Deepak; BV, Murali Mohan; Tripathi, S. K.; Swarnakar, Rajesh; Trivedi, Sonali; Srinivas, R.; Padmanabhan, Arjun; Archana, B; Anand, Mahesh Padukudru; Ghewade, Babaji; Nair, Girija; Jindal, Aditya; Jayadevappa, Gayathri Devi H; Sawhney, Honney; Sarmah, Kripesh Ranjan; Kaushik, Sushmita; Suresh, Anantharaj; Khanna, Arjun; Gami, Samir; Shah, Arti; Shah, Arpan; Dutt, Naveen; Garg, Himanshu; Vyas, Sunil; Venugopal, Kummannoor; Prasad, Rajendra; Aleemuddin, Naveed M; Karmakar, Saurabh; Singh, Virendra; Sk, Jindal; Sharma, Shubham; Prajapat, Deepak; Chandrashekar, Sagar; Loebinger, Michael R.; Mishra, Aditi; Blasi, Francesco; Ramanathan, Ramanathan Palaniappan; Goeminne, Pieter; Vasudev, Preethi; Shoemark, Amelia; Siddaiah, Jayaraj Biligere; Kungwani, Rahul; Das, Akanksha; Sawhney, Mehneet; Polverino, Eva; Welte, Tobias; Gulecha, Nayan Sri; Shteinberg, Michal; Mangala, Anshul; Shah, Palak; Chauhan, Nishant Kumar; Jajodia, Nikita; Singhal, Ashutosh; Batra, Sakshi; Hasan, Ashfaq; Aliberti, Stefano; Crichton, Megan; Limaye, Sneha; Salvi, Sundeep; Chalmers, James D.

doi:10.1183/13993003.00611-2022

Cited by 25 publications

(10 citation statements)

References 31 publications

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“…Although it had a small sample size, the US study found that 44% of patients used PEP devices and 10% used HFCWO at baseline, in contrast to our European data where only 16% used devices and HFCWO was not used in most European countries, and the country with the highest use only had a frequency of 1.9%. These data emphasise global variation in practice, likely reflecting differences in reimbursement practices as well as lack of availability of specialist chest physiotherapists in many countries [ 24 , 32 ]. It should be noted that, while we had a large sample size overall, the numbers in individual countries varied.…”

Section: Discussionmentioning

confidence: 99%

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Airway clearance management in people with bronchiectasis: data from the European Bronchiectasis Registry (EMBARC)

Spinou,

Hererro-Cortina,

Aliberti

et al. 2024

Eur Respir J

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BackgroundInternational guidelines recommend airway clearance management as one of the important pillars of bronchiectasis treatment. However, the extent to which airway clearance is used for people with bronchiectasis in Europe is unclear. The aim of the study was to identify the use of airway clearance management in patients with bronchiectasis across different countries and factors influencing airway clearance use.MethodsProspective observational study using data from the EMBARC Registry between January 2015 and April 2022. Pre-specified options for airway clearance management were recorded, including airway clearance techniques, devices and use of mucoactive drugs.Results16 723 people with bronchiectasis from 28 countries were included in the study. Mean age was 67 years (interquartile range 57–74 years, range 18–100 years) and 61% were females. Seventy-two percent of the participants reported daily sputum expectoration and 52% (95% CI 51–53%) of all participants reported using regular airway clearance management. Active cycle of breathing technique was used by 28% of the patients and airway clearance devices by 16% of participants. The frequency of airway clearance management and techniques used varied significantly between different countries. Patients who used airway clearance management had greater disease severity and worse symptoms, including a higher daily sputum volume compared to those who did not use it regularly. Mucoactive drugs were also more likely to be used in patients with more severe disease. Access to specialist respiratory physiotherapy was low throughout Europe, but particularly low in Eastern Europe.ConclusionsOnly half of the people with bronchiectasis in Europe use airway clearance management. Use and access to devices, mucoactive drugs and specialist chest physiotherapy appears to be limited in many European countries.

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Section: Discussionmentioning

confidence: 99%

“…Bronchiectasis is a heterogeneous disease and mucus properties are highly heterogeneous between individuals. It is important that future studies generate a more robust evidence base for ACT in addition to identifying appropriate precision medicine approaches [ 3 , 24 , 33 – 35 ].…”

Section: Discussionmentioning

confidence: 99%

Airway clearance management in people with bronchiectasis: data from the European Bronchiectasis Registry (EMBARC)

Spinou,

Hererro-Cortina,

Aliberti

et al. 2024

Eur Respir J

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“…EMBARC is a prospective observational study of patients with computed tomography (CT)-confirmed bronchiectasis conducted across more than 30 countries worldwide [ 13 , 14 ]. The registry includes European Union (EU) countries, non-EU European countries and several non-European countries (Israel, India, Kyrgyzstan and Pakistan) [ 14 , 15 ]. The study is approved by the ethical committee in the host country (UK) and by institutional review boards or ethics committees in all countries and regions in which the study is conducted.…”

Section: Methodsmentioning

confidence: 99%

Objective sputum colour assessment and clinical outcomes in bronchiectasis: data from the European Bronchiectasis Registry (EMBARC)

Aliberti,

Ringshausen,

Dhar

et al. 2024

Eur Respir J

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IntroductionA validated 4-point sputum colour chart can be used to objectively evaluate the levels of airway inflammation in bronchiectasis patients. In the EMBARC registry, we tested whether sputum colour would be associated with disease severity and clinical outcomes.MethodsProspective, observational registry of adults with bronchiectasis conducted in 31 countries. Patients who did not produce spontaneous sputum were excluded from the analysis. The Murray sputum colour chart was used at baseline and at follow-up visits. Key outcomes were frequency of exacerbations, hospitalizations for severe exacerbations and mortality during up to 5 years follow-up.Results13 484 patients were included in the analysis. More purulent sputum was associated with lower FEV1, worse quality of life, greater bacterial infection, and a higher bronchiectasis severity index.Sputum colour was strongly associated with the risk of future exacerbations during follow-up. Compared to patients with mucoid sputum (1.0 reference), patients with mucopurulent sputum experienced significantly more exacerbations (Incident rate ratio (IRR) 1.26 95%CI 1.19–1.33, p<0.0001), while the rates were even higher for patients with purulent (IRR 1.45 95%CI 1.36–1.55, p<0.0001), and severely purulent sputum (IRR 1.54 95%CI 1.26–1.89, ted with increasing sputum colour with rate ratios, compared to patients with mucoid sputum, of 1.29 (95%CI 1.19–1.39, p<0.0001), 1.73 (95%CI 1.58–1.90, p<0.0001) and 2.01 (95%CI 1.54–2.63, p<0.0001) for mucopurulent, purulent and severely purulent sputum, respectively. . Mortality was significantly increased with increasing sputum purulent, hazard ratio 1.12 (95%CI 1.01–1.24, p=0.027), for each increment in sputum purulence.ConclusionSputum colour is a simple marker of disease severity and future risk of exacerbations, severe exacerbations and mortality in patients with bronchiectasis.

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“…Bronchiectasis is a chronic respiratory disease where people suffer ongoing symptoms of cough, sputum production and frequent respiratory infections, leading to progressive lung function decline and reduced quality of life [1][2][3] . The disease is defined by abnormal, permanent dilation of the bronchi resulting in impaired clearance of mucus from the airways.…”

Section: Introductionmentioning

confidence: 99%

Global genomic diversity ofPseudomonas aeruginosain bronchiectasis

Harrington,

Kottara,

Cagney

et al. 2024

Preprint

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Background. Pseudomonas aeruginosa is the dominant pathogen causing lung infections in people with both cystic fibrosis (CF) and bronchiectasis, associated with poorer outcomes. Unlike CF, bronchiectasis has been a neglected disease. More extensive genomic studies of larger bronchiectasis patient cohorts and within patient sampling are needed to improve understanding of the evolutionary mechanisms underpinning P. aeruginosa infections to guide novel and improved treatments. Methods. We have performed genome sequencing of 2,854 P. aeruginosa isolates from 180 patients attending clinics worldwide to analyse the genomic diversity between and within patient infections. Results. We observed high genetic diversity between infections with low incidence of highly transmissible strains. Our genomic data provide evidence for the mutational targets driving P. aeruginosa evolution in bronchiectasis. Some functions found to gain mutations were comparable to CF, including biofilm and iron acquisition, whilst others highlighted distinct evolutionary paths in bronchiectasis such as pyocin production and resistance, and a novel efflux pump gene (PA1874). We also show a high incidence of antimicrobial resistance-associated mutations and acquired resistance genes, in particular multidrug efflux and fluoroquinolone resistance mechanisms. Conclusions. Our findings highlight important differences between P. aeruginosa infections in bronchiectasis and CF and provide evidence of the relatively minor role transmissible strains play in bronchiectasis. Our study provides a 10-fold increase in the available genomic data for these infections and is a global resource to improve our knowledge and understanding, to facilitate better patient outcomes.

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Clinical outcomes of bronchiectasis in India: data from the EMBARC/Respiratory Research Network of India registry

Cited by 25 publications

References 31 publications

Airway clearance management in people with bronchiectasis: data from the European Bronchiectasis Registry (EMBARC)

Airway clearance management in people with bronchiectasis: data from the European Bronchiectasis Registry (EMBARC)

Objective sputum colour assessment and clinical outcomes in bronchiectasis: data from the European Bronchiectasis Registry (EMBARC)

Global genomic diversity ofPseudomonas aeruginosain bronchiectasis

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