Management of bronchiectasis in Europe: Data from the European bronchiectasis registry (EMBARC)

Introduction: There are no published data on the management of bronchiectasis across Europe. Methods: The European Bronchiectasis registry (EMBARC) is a prospective observational study of patients with HRCT confirmed bronchiectasis. Data on current treatments were evaluated in relation to severity of disease and bacterial infection. Results: 2031 patients were included from 23 European Countries. Mean age was 63 years and 58% were female. The most common aetiologies were idiopathic (39%) and post-infective (27%). Mean FEV1 was 71% predicted. 51.3% had 2 or more exacerbations/year and 20.5% of patients were infected with Pseudomonas aeruginosa. The most common treatment across the population was inhaled corticosteroids (ICS- 55%), usually in combination with long acting beta-agonists (56.4%). Inhaled antibiotics were used in 10.8% (predominantly colistin 65.9%). Long term (>28 days) oral antibiotics were used in 19.4% (azithromycin- 74.2%). Mucoactive drugs were infrequently used. There was a significantly higher use of long term antibiotics in more severe patients, assessed by the bronchiectasis severity index (p<0.0001) P. aeruginosa infection strongly influenced treatment patterns, with increased use of ICS (78.4%,p=0.005), inhaled antibiotics (40.4%,p<0.0001) and long term oral antibiotics (28.3%,p<0.0001). 12.3% were prescribed combined inhaled antibiotics and azithromycin. Only 10.4% using inhaled antibiotics did not have a history of P. aeruginosa infection. Conclusions:P. aeruginosa infection is the primary driver for long term antibiotic treatment. The EMBARC registry will provide a useful benchmark to evaluate the impact of the upcoming ERS guidelines on clinical practice.