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

Introduction A 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. Methods Prospective, 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. Results 13 484 patients were included in the analysis. More purulent sputum was associated with lower FEV 1 , 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. Conclusion Sputum colour is a simple marker of disease severity and future risk of exacerbations, severe exacerbations and mortality in patients with bronchiectasis.