Inhaled Corticosteroid Therapy in Bronchiectasis is Associated with All-Cause Mortality: A Prospective Cohort Study

Figures & data

Table 1 Demographics, Lung Function and Symptoms of 264 Respiratory Outpatients with Bronchiectasis Followed for 5 Years at Two University Hospitals

Demographics	N = 264^a
Age (years)	66 (51–72)
Female	165 (62%)
BMI (kg/m^2)	24.5 (21.8–27.1, N=226)
Smoking Status
Never Smokers	112 (45%)
Ex-Smokers	117 (47%)
Current Smokers	22 (8.8%)
Pack-Years	15 (2–30, N=139)
BSI Score	6.0 (5.0–9.0, N=86)
COPD Diagnosis	65 (25%)
Asthma Diagnosis	72 (27%)
Aetiologies^b
Allergic Bronchopulmonary Aspergillosis	15 (5.7%)
Connective Tissue Disease	31 (12%)
Inflammatory Bowel Disease	17 (6.7%)
Childhood Severe Pulmonary Disease	30 (11%)
Immunosuppression (Idiopathic and Pharmacologic)	12 (4.8%)
Idiopathic Bronchiectasis	177 (67%)
Lung Function and Symptoms	No ICS, N = 139	ICS-Treated, N = 122^a	p-value^c
FEV1 (L)	2.22 (1.79–2.80) (N=131)	1.71 (1.31–2.33) (N=118)	<0.001
% Predicted	80.9 (71.2–93.1) (N=119)	65.2 (48.6–83.1) (N=104)	<0.001
FVC	2.90 (2.42–3.48) (N=128)	2.56 (1.97–3.30) (N=116)	0.003
% Predicted	82.5 (68.8–89.6) (N=118)	75.2 (59.0–87.3) (N=104)	0.010
FEV1/FVC ratio	0.77 (0.71–0.81) (N=128)	0.70 (0.59–0.78) (N=116)	<0.001
>0.8	39 (30%)	22 (19%)	0.038
<0.7	22 (17%)	59 (51%)	<0.001
Chronic Cough	109 (71%, N=134)	103 (91%, N=113)	0.028
Chronic Sputum Production	91 (71%, N=129)	100 (89%, N=112)	<0.001
Chronic Dyspnoea	43 (34%, N=126)	68 (64%, N=107)	<0.001
Chronic Sinusitis	8 (7.6%, N=105)	6 (8.7%, N=69)	0.8

Notes: ^aStatistics presented: median (interquartile range); n (%). N denotes number of patients with data available. ^bSum >100% due to multiple possible aetiologies per patient. ^cStatistical tests performed: Wilcox test; chi-squared.

Abbreviations: BSI, Bronchiectasis Severity Index; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; ICS, inhaled corticosteroids.

Table 2 Pharmacological and Non-Pharmacological Treatment Strategies in 264 Respiratory Outpatients with Bronchiectasis Followed for 5 Years at Two University Hospitals, Stratified by Treatment with Inhaled Corticosteroids

Treatment Strategies	No ICS, N = 139^a	ICS-Treated, N = 122^a	p-value^b
ICS Treatment		122 (100%)	N/A
Without Asthma or COPD		23 (21%)	N/A
High-Dose ICS Treatment		29 (24%)	N/A
Without Asthma or COPD		8 (35%)	N/A
With Asthma		14 (11%)	N/A
With COPD		11 (9.0%)	N/A
LAMA Treatment	11 (7.9%)	44 (36%)	<0.001
Without Asthma or COPD	3 (27%)	5 (11%)	0.5
With Asthma	2 (1.4%)	16 (13%)	<0.001
With COPD	6 (4.3%)	30 (25%)	0.015
LABA Treatment	10 (7.2%)	97 (80%)	<0.001
Without Asthma or COPD	5 (50%)	15 (15%)	0.009
With Asthma	1 (0.7%)	50 (41%)	<0.001
With COPD	4 (2.9%)	45 (37%)	<0.001
Prophylactic Antibiotics	7 (5.0%)	19 (16%)	0.005
PEP-Device	106 (99%, N=107)	96 (98%, N=98)	0.6
Pulmonary Physiotherapy	56 (72%, N=78)	55 (67%, N=82)	0.5

Notes: ^aStatistics presented: n (%). No missing data unless specified, N denotes number of patients with data available. Note that sums >100% due to concurrent diagnoses of asthma and COPD. ^b Statistical tests performed: chi-squared.

Abbreviations: COPD, chronic obstructive pulmonary disease; ICS, inhaled corticosteroid; LABA, long-acting beta₂ agonist; LAMA, long-acting muscarinic antagonist; PEP, positive expiratory pressure.

Table 3 Burden of Disease in 264 Respiratory Outpatients with Bronchiectasis Followed for 5 Years at Two University Hospitals, Stratified by Treatment with Inhaled Corticosteroids

Colonization and Exacerbations	No ICS, N = 139^a	ICS-Treated, N = 122^a	p-value^b
Sputum Culture Performed	72 (52%)	87 (71%)	0.001
Positive Sputum Culture	29 (21%)	39 (32%)	0.041
P. aeruginosa-Positive Sputum Culture	9 (6.5%)	24 (20%)	0.001
History of Any Exacerbations 12 Months Prior to Baseline	73 (54%, N=134)	82 (70%, N=117)	0.011
Of which History Moderate Exacerbations	73 (54%, N=134)	81 (70%, N=116)	0.013
Of Which History of Severe Exacerbations	29 (21%)	50 (41%)	<0.001
Annual Exacerbation Rate per Patient during Follow-Up	0.87 (1.33)	1.36 (1.76)	0.012
Of Which Moderate Exacerbations	0.74 (1.05)	1.00 (1.32)	0.089
Of Which Severe Exacerbations	0.13 (0.50)	0.36 (0.86)	0.008
Deceased at End of Follow-Up	14 (10%)	25 (20%)	0.023

Notes: ^aStatistics presented: n (%); mean (SD). No missing data unless specified, N denotes number of patients with data available. ^b Statistical tests performed: chi-squared, Welch two-sample t-test.

Abbreviation: ICS, inhaled corticosteroid.

Table 4 HR of All-Cause Mortality in 264 Respiratory Outpatients with Bronchiectasis Followed for 5 Years at Two University Hospitals, Calculated Using Cox Regression

Mortality Regression Analyses	Bivariable Cox Regression			Multivariable Cox Regression
	HR	95% CI	p-value	HR	95% CI	p-value
ICS Treatment
No ICS Treatment	1			1
Low-to-Moderate Dose	1.54	0.73, 3.23	0.3	0.86	0.30, 2.46	0.8
High Dose	4.66	2.12, 10.3	<0.001	4.93	1.73, 14.0	0.003
Age				1.10	1.05, 1.14	<0.001
Female				0.62	0.27, 1.44	0.3
Smoking Status
Never-smoker				1
Ex-Smoker				0.81	0.34, 1.91	0.6
Current Smoker				1.64	0.40, 6.79	0.5
FEV1
>70%				1
50% to 70%				1.15	0.45, 2.90	0.8
<50%				3.72	1.30, 10.7	0.015
Asthma or COPD Diagnosis				1.40	0.53, 3.71	0.5

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in 1 second; HR, hazard ratio; ICS, inhaled corticosteroid.