The bronchiectasis exacerbation definition in a real-world setting: data from the EMBARC registry

In 2017 EMBARC and BRR published a consensus definition of bronchiectasis exacerbation (BEX) for use in clinical studies. Validation in a real-world setting is needed. The EMBARC exacerbation sub-study is a nested observational cohort within the larger EMBARC registry, enrolling patients during an exacerbation defined by clinicians’ judgement. Patients were classified using BEX symptoms into two study groups: those consistent (A) or not consistent (B) with the EMBARC/BRR definition. 321 (62.6% female, median age 64) patients were enrolled from 15 different countries: 81% met the EMBARC/BRR definition (Group A). The most common symptoms of BEX in Group A were cough (96.2%), increased sputum volume (86.5%) and purulence (81.9%), while those in Group B had cough (42.6%), increased dyspnoea (34.4%) and fatigue (34.4%). Patients in Group A were significantly more severe than Group B in terms of BSI, FEV1 and daily sputum volume during stable state. A significantly different prevalence of BEX patients fulfilling the EMBARC/BRR definition was found when the population was stratified according to comorbid COPD and asthma (table). <b>Conclusion:</b> Up to one fifth of BEX treated by clinicians in real-life cannot be detected using the EMBARC/BRR definition. The presence of asthma as a comorbidity is associated with different exacerbation symptoms. <b>Acknowledgments:</b> EMBARC has received support from the EU/EFPIA Innovative Medicines Initiative Joint Undertaking iABC grant agreement no 115721