Clinical heterogeneity of bronchiectasis exacerbations: a multicentre real-world study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background and aim Exacerbations are critical events in the natural history of bronchiectasis. While an international definition has been proposed for clinical trials by an EMBARC/BRR task force, the clinical presentation of exacerbations varies considerably among patients. The aim of our study was to assess the clinical heterogeneity of signs and symptoms of bronchiectasis exacerbations in a real-world setting. Methods This was a multicentre cross-sectional study involving nine bronchiectasis centres in Italy. Consecutive adults with bronchiectasis reported symptoms during stable-state and during typical exacerbations over the past 2 years. Symptom frequency, their impact on daily life, and concordance with the 2017 EMBARC/BRR definition were assessed overall and by comorbidity/infection subgroups. Results We enrolled 367 patients (79% female; median age 65 years). During exacerbations, cough (87%), increased sputum volume (81%), and purulence (77%) predominated and clustered with fatigue (72%) and exertional dyspnoea (64%). Patients ranked cough and sputum changes as highest impact. Overall, 85% of typical exacerbations met EMBARC/BRR criteria; exacerbation events that were not concordant with EMBARC/BRR criteria were more frequent in patients with NTM-PD (p=0.004). Patients with asthma/COPD as comorbidity reported more dyspnoea and wheezing, patients with chronic P. aeruginosa infection more frequently reported haemoptysis and nocturnal dyspnoea. Conclusions Exacerbations present with distinct symptom patterns across subgroups, and about one in seven typical patient reported events do not meet consensus criteria, underscoring the need for more sensitive patient-centred definitions.
Source: ERJ Open Research
Authors: Angela Tramontano, Mattia Nigro, Edoardo Simonetta, Paola Scarano, Alessandro De Angelis, Veronica Polelli, Emanuele Toni, Giacomo Barzaghi, Salvatore Battaglia, Martina Bonifazi, Raffaele Campisi, Giovanna Elisiana Carpagnano, Marianna Cicchetti, Vittoria Comellini, Valentina Conio, Claudia Crimi, Claudia Duranti, Paola Faverio, Donato Lacedonia, Martina Lo Casto, Martina Marchello, Lucrezia Pisanu, Michela Salvemini, Mariarosaria Vulpi, Anna Stainer, Francesco Amati, Mariangela Valentina Puci, Giovanni Sotgiu, Matteo Bonini, Paolo Palange, Antonio Voza, James D. Chalmers, Andrea Gramegna, Francesco Blasi, Stefano Aliberti
Institutions: IRCCS Humanitas Research Hospital, Humanitas University, University of Milano-Bicocca, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" di Palermo, University of Palermo, Marche Polytechnic University, Azienda Ospedaliero-Universitaria delle Marche, Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco", University of Bari Aldo Moro, University of Bologna, University of Pavia, Policlinico San Matteo Fondazione, University of Foggia, University of Sassari, Azienda Ospedaliero Universitaria di Sassari, Sapienza University of Rome, University of Dundee, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $808
Funder: Ministero della Salute
OpenAlex ID: W7203826549
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