Quality of care in bronchiectasis using the European Respiratory Society Guidelines as a reference standard- data from the EMBARC registry

<b>Introduction:</b> Quality of care in bronchiectasis has historically been suboptimal. The ERS released guidelines in 2017 designed to improve clinical management. We aimed to determine the quality of care using the ERS guidelines as a reference standard. <b>Methods:</b> Guideline adherence in patients enrolled to the European Bronchiectasis Registry before and after publication of the ERS guidelines (2015-2017, and 2017-2019) was measured according to a series of standards G1. Testing for immunoglobulins and ABPA G2. Sputum culture sent when clinically stable G3. Eradication of Pseudomonas aeruginosa at first isolation G4. Long term antibiotic treatment if 3 or more exacerbations per year, G5. Bronchodilator treatment if significant breathlessness G6. Airway clearance therapy G7. Pulmonary rehabilitation for all patients with significant breathlessness. To account for differences in patient characteristics logistic regression models were adjusted for country and for severity of disease. <b>Results:</b> 18927 patients were enrolled from 32 countries. Quality of care improved in the post guideline period: G1: 1.72 95%CI 1.58-1.92,p&lt;0.0001, G2: OR 1.44 95%CI 1.31-1.57,p&lt;0.0001), G3: 1.21 95%CI 1.07-1.37,p=0.002 G4: OR 1.37 95%CI 1.18-1.60,p&lt;0.0001, G5: 1.27 95%CI 1.10-1.46,p=0.001. G6: OR 1.13 95%CI 1.06-1.21,p=0.001, G7: 1.10 95%CI 0.95-1.27,p=0.2. Despite improvements, no measure was adhered to in &gt;80%. <b>Conclusion:</b> Quality of care for bronchiectasis patients in Europe has significantly improved since 2017. This work was supported by the Innovative Medicines Initiative (IMI) and EFPIA companies under the European Commission funded project, iABC (grant 115721)