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The frequent exacerbator phenotype in bronchiectasis revisited: Data from EMBARC registry
Oriol Sibila1, Lidia Perea2, Pierre Regis Burgel3
1Respiratory Department, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERES, Barcelona, Spain.
Summary
In bronchiectasis, each prior exacerbation increases future risk, with no specific threshold for frequent exacerbators. This pattern holds true across various causes and geographic regions.
Area of Science:
- Pulmonology
- Clinical Medicine
- Epidemiology
Background:
- The definition of frequent exacerbators in bronchiectasis (≥3 exacerbations/year) needs refinement.
- Understanding the cumulative risk of prior exacerbations and the impact of severe events is crucial.
Purpose of the Study:
- To quantify the risk of future exacerbations and severe exacerbations based on prior exacerbation history.
- To assess if this risk association varies by bronchiectasis etiology and geographic region.
Main Methods:
- Analysis of data from the European Bronchiectasis Registry (EMBARC), encompassing 30 countries.
- Negative binomial regression used to model the association between exacerbation history and future events over 5 years.
- Severe exacerbations defined as those requiring hospitalization.
Main Results:
- Each prior exacerbation significantly increased the risk of future exacerbations and severe exacerbations.
- The risk escalated progressively with more prior exacerbations (e.g., 4+ prior exacerbations increased risk by 3.56-fold).
- A single prior severe exacerbation strongly predicted future severe exacerbations (IRR=3.96).
Conclusions:
- The frequent exacerbator phenotype in bronchiectasis is consistent across diverse patient subgroups and regions.
- There is no definitive threshold; each prior exacerbation contributes to a progressively higher risk.
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