The presence of respiratory symptoms such as cough, shortness of breath and sputum production during the stable phase of the disease is associated with a worse prognosis and a different response to treatment in patients with bronchiectasis.
The study was led by Oriol Sibila, head of the Pulmonology Service at the Clínic and researcher in the IDIBAPS Inflammation and Repair in Respiratory Diseases group, and Lídia Perea, postdoctoral researcher in the same IDIBAPS group. Antoni Torres, head of the IDIBAPS Applied Research in Infectious Respiratory Diseases and Critically Ill Patients group, also participated.
What is bronchiectasis?
Bronchiectasis is a chronic respiratory condition characterized by the abnormal and permanent dilatation of the bronchi. It affects between 40 and 50 people per 100,000 inhabitants, with a higher prevalence in women. This disease has a significant impact on quality of life, as many patients present chronic symptoms such as cough, sputum production, shortness of breath, and fatigue. In addition, they may experience episodes of repeated respiratory infections, known as exacerbations, which are the main risk factor for developing further infections, and complicate the prognosis.
Symptoms and risk of exacerbations: new evidence
The study used data from the international EMBARC registry, which includes almost 17,000 patients from over 30 countries in Europe and Asia, including over 200 patients from the Hospital Clínic.
Through validated quality-of-life questionnaires that record respiratory symptoms, it has been observed that patients with more respiratory symptoms have a risk of exacerbations similar to those who have already experienced them previously, demonstrating that symptoms are an independent risk factor for poor prognosis.
This finding provides a new perspective on the management of the disease, as until now only the number of exacerbations was considered when deciding on chronic treatment.
Treatment and response to macrolides
In addition, the study analysed data from three clinical trials on the use of macrolides, antibiotics with anti-inflammatory action, and demonstrated that these drugs reduce the risk of new exacerbations in both patients with frequent exacerbations and those with more symptoms, regardless of whether they had previous exacerbations. This opens the door to considering new criteria for prescribing chronic treatments in these patients.
Implications and future
These findings could change clinical guidelines, incorporating the presence of symptoms as a criterion for initiating preventive and personalized treatments, with the aim of improving the quality of life and prognosis of patients with bronchiectasis. Research into this disease is advancing rapidly, and new treatments are expected to be introduced in the coming years.
Study reference:
Sibila O, Stobo J, Perea L, Gao Y-H, Xu J-F, Lind H, et al. Symptoms, risk of future exacerbations and response to long-term macrolide treatment in Bronchiectasis: an observational study. Lancet Respir Med. 2025.
