TOPLINE:

Prior exacerbations and greater symptom severity independently predicted future exacerbations in patients with bronchiectasis. Long-term macrolide proved beneficial not only for patients with frequent exacerbations but also for those with few prior exacerbations who endured a high symptom burden.

METHODOLOGY:

• Researchers conducted an observational study to assess the association between symptom burden and the risk for future exacerbations in patients with bronchiectasis and whether the use of long-term macrolides can reduce this risk.
• Data on 9466 participants were collected from the European Bronchiectasis Registry (median age, 68 years; 60.9% women; median bronchiectasis severity index score, 7); baseline symptom burden was evaluated using the quality-of-life bronchiectasis questionnaire respiratory symptom score (QOL-B-RSS, high scores indicating mild symptoms).
• Patients were followed up for exacerbations for 1 year post-baseline.
• A post hoc pooled analysis of data from three trials on macrolide therapy examined the relationship between baseline symptom burden and response to long-term macrolide therapy in patients with bronchiectasis.

TAKEAWAY:

• Each additional previous exacerbation raised the risk for subsequent events by 11%, while each 10-point decrease in QOL-B-RSS score corresponded to a 10% higher risk (P < .0001 for both).
• Patients with three prior exacerbations and average symptom scores experienced 1.58 exacerbations per year (95% CI, 1.48-1.69), similar to those with no prior exacerbations but worse symptom scores, who experienced 1.55 exacerbations per year (95% CI, 1.41-1.70).
• The number of patient-years needed to prevent one exacerbation with long-term macrolide therapy was comparable between patients with frequent prior exacerbations and average symptom scores (1.45; 95% CI, 1.08-2.24) and those with one prior exacerbation but high symptom scores (1.43; 95% CI, 1.06-2.18).
• No evidence of an interaction between macrolide use and the effect of either prior exacerbation frequency or symptom score in predicting future exacerbations was found (P = .72).

IN PRACTICE:

“We have shown that patients who are highly symptomatic with bronchiectasis are at higher risk of exacerbation independently of previous exacerbation and severity of the disease and that they can benefit from long-term macrolide treatment,” the authors of the study wrote.

SOURCE:

The study was led by Oriol Sibila, PhD, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, CIBERES in Barcelona, Spain. It was published online on August 27, 2025, in The Lancet Respiratory Medicine.

LIMITATIONS:

The study was limited by potential recall bias in patient‐reported QOL scores, reliance on the generic St George’s Respiratory Questionnaire (rather than bronchiectasis‐specific tools) in the macrolide trials, and post hoc analyses that excluded participants with missing data for baseline symptoms or follow‐up.

DISCLOSURES:

The study was supported by the EU, the European Federation of Pharmaceutical Industries and Associations, the Innovative Medicines Initiative, the Inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis consortium, and the European Respiratory Society. Several authors reported receiving financial aid from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.