Hospitalisations for bronchiectasis compared to COPD and asthma in the USA

Understanding how bronchiectasis hospitalisations differ from those of COPD and asthma could guide clinical practice and improve care. This study aims to compare outcomes of hospitalisations for bronchiectasis exacerbation with those for COPD and asthma exacerbations.

This study used a US all-payer database to evaluate hospitalisations for bronchiectasis, COPD and asthma exacerbations from January 2017 to December 2021. Demographic data, hospital characteristics, comorbidities, costs, length of stay and mortality were analysed. Associations between the SARS-CoV-2 pandemic and hospitalisation incidence and mortality were also assessed. A secondary analysis examined outcomes in bronchiectasis exacerbation with overlapping airway diseases.

The bronchiectasis cohort (n=232 825) had a median age of 72 years (IQR: 57-81); 59% were female and 73% were white. Compared to COPD and asthma, hospitalisations for bronchiectasis had longer median stays (5 versus 4 versus 3 days) and higher median costs (USD 50 393 versus USD 38 040 versus USD 31 262). After adjusting for age, year of hospitalisation and comorbidity burden, hospitalisations for bronchiectasis were 1.2 times more likely to result in death than for COPD, and 3.0 times more likely than for asthma (p<0.0001). During the pandemic years (2020-2021), hospitalisations for bronchiectasis declined by only 8%, compared to 26% for COPD and 28% for asthma, while mortality increased across all cohorts. Overlap of bronchiectasis exacerbation with COPD or asthma did not result in higher mortality than bronchiectasis alone.

Hospitalisations for bronchiectasis in the USA are associated with worse outcomes, including higher mortality, costs and length of stay, compared to those for COPD and asthma exacerbations.