Late Breaking Abstract - Inhaled corticosteroids in bronchiectasis is associated to increased morbidity, Pseudomonas colonization and mortality – a five-year prospective cohort study

Abstract

Background and Objective: Prescribing inhaled corticosteroids (ICS) for bronchiectasis (BE) is controversial, with current guidelines from the ERS recommending against a one-size fits all approach. Studies on the real-world ICS treatment prevalence and on the long-term effects on morbidity in bronchiectasis are lacking.

Methods: This study comprises all patients with BE managed at outpatient clinics in two university hospitals in the Capital Region of Denmark between 2014-15. Demographics, co-diagnoses, lab and prescription data was acquired from patient journals. Patients were followed until April 2020.

Results: Of 285 included patients, 131 (46%) of patients were prescribed ICS treatment. No difference in age, gender or smoking status was seen between ICS-treated and non-ICS-treated groups. At baseline, 18% of ICS treated patients had no concomitant diagnosis of asthma or COPD. At follow-up, this had increased to 23%.

Patients prescribed ICS had a higher symptom burden in terms of cough (p 0.028), sputum production (p <0.0001) and dyspnea (p <0.0001). The relative risk of Pseudomonas positive sputum culture with ICS treatment was 1.21 (95% CI 1.01-1.44, p 0.045).

ICS treatment was associated with increased risk of exacerbations requiring hospitalization (RR 1.91 (95% CI 1.27-2.87, p 0.0002) and the relative mortality risk with ICS treatment was 1.12 (95% CI 1.00-1.24, p 0.036).

Conclusions: In this cohort, 23% of patients with BE were treated with ICS despite no underlying diagnosis of asthma or COPD. Overall, ICS treatment was associated with more severe exacerbations, risk of Pseudomonas colonization and higher mortality.