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BackgroundIdentifying risk factors for poor outcomes can help with risk stratification and targeting of treatment. Risk factors for mortality and exacerbations have been identified in bronchiectasis but have been almost exclusively studied in European and North American populations. This study investigated the risk factors for poor outcome in a large population of bronchiectasis patients enrolled in India.MethodsThe European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India (EMBARC-India) registry is a prospective observational study of adults with computed tomography-confirmed bronchiectasis enrolled at 31 sites across India. Baseline characteristics of patients were used to investigate associations with key clinical outcomes: mortality, severe exacerbations requiring hospital admission, overall exacerbation frequency and decline in forced expiratory volume in 1 s.Results1018 patients with at least 12-month follow-up data were enrolled in the follow-up study. Frequent exacerbations (≥3 per year) at baseline were associated with an increased risk of mortality (hazard ratio (HR) 3.23, 95% CI 1.39–7.50), severe exacerbations (HR 2.71, 95% CI 1.92–3.83), future exacerbations (incidence rate ratio (IRR) 3.08, 95% CI 2.36–4.01) and lung function decline. Coexisting COPD, dyspnoea and current cigarette smoking were similarly associated with a worse outcome across all end-points studied. Additional predictors of mortality and severe exacerbations were increasing age and cardiovascular comorbidity. Infection with Gram-negative pathogens (predominantlyKlebsiella pneumoniae) was independently associated with increased mortality (HR 3.13, 95% CI 1.62–6.06), whilePseudomonas aeruginosainfection was associated with severe exacerbations (HR 1.41, 95% CI 1.01–1.97) and overall exacerbation rate (IRR 1.47, 95% CI 1.13–1.91).ConclusionsThis study identifies risk factors for morbidity and mortality among bronchiectasis patients in India. Identification of these risk factors may support treatment approaches optimised to an Asian setting.

Bronchiectasis is reported to be more frequent in females. There have been no large studies examining the impact of biological sex on disease characteristics, aetiology, severity, quality of life or management. Patients were prospectively enrolled from 2015 -2018 in 3 linked bronchiectasis registries in Australia, Europe and India. Disease information was collected, including quality of life (QoL-B). Analyses were conducted cross-sectionally using baseline data. 13859 patients were included from 29 countries. 57.6% were female. The highest proportion of females were in Australia (70.9%) and lowest in India (43.1%). Male sex was associated with bronchiectasis caused by COPD and TB; while female sex was associated with post-infectious bronchiectasis, asthma, connective tissue disease and NTM. Men had more severe disease as measured by the bronchiectasis severity index, but females more likely to be infected with Pseudomonas aeruginosa. Women had greater disease impact across multiple QoL-B domains including social, emotional and treatment burden domains. Cough and sputum purulence were more severe in women while men most frequently complained of wheeze and breathlessness. Men were significantly less likely to receive evidence based interventions including testing for immunodeficiency and ABPA, long term antibiotic treatment for frequent exacerbators, pulmonary rehabilitation and airway clearance techniques. Conclusion: There are striking sex differences in aetiology, severity, quality of life and treatment in patients with bronchiectasis

Introduction: Allergic bronchopulmonary aspergillosis (ABPA) is a severe allergic inflammatory response to Aspergillus fumigatus and is often an unrecognized cause for bronchiectasis. Aims and Objectives: In this study, we aim to examine the burden of ABPA in the India bronchiectasis registry, the screening test perform and the phenotype characterization. Material and Methods: Among the 2197 cases of bronchiectasis enrolled in the Indian bronchiectasis registry, we examined the number of patients screened for ABPA and the proportion of screened positive ABPA cases. We also looked for phenotypic characterization using HRCT features, total IgE, eosinophil count, IgE and IgG specific to aspergillus and by skin prick test. Results: Out of 2197 cases of bronchiectasis cases register at 31 sites, only 387 (17%) cases were screened for ABPA 190 (49.1%) at 24 sites. Among these 190 cases, 99(52.1%) of all ABPA cases were male (mean age 44.85 ± 15.09 yr). 62.03% had the bronchiectasis for more than five years. Serum eosinophil count was raised in 115(60.5%) out of 146 (76.84%) cases. Raised IgG level was observed in 71 (74.74%) out of 95 (50%) cases. Specific IgE to aspergillus was raised in 117 (84.17%) out of 139 (73.16%) cases. Aspergillus skin prick test was tested positive in 83 (83%) out of 100 (52.63%) cases. Total IgE count was raised in 97 (54.19%) cases out of 179 (94.2%). Obstructive airways disease was found in 74 (52.5%) out of 141 (74.21%) cases tested by spirometry. The right middle lobe was involved in 66.32% cases in HRCT. Conclusion: Despite the universal screening for ABPA recommended by the ERS, only 17% were screened for ABPA of which 50% showed evidence of underline ABPA.

Introduction: Bronchiectasis is a heterogeneous disease. Previous phenotyping of this disease has been based solely on 5 European databases which do not really account for the remaining world population. Aims and Objectives: This study looked at the Indian EMBARC Registry to try and identify discrete patient groups with different clinical and biological characteristics. Methodology: Principal component and cluster analyses were performed using demographics, co-morbidities, clinical, radiological, physiological and microbiological variables collected during the stable disease state. Results: The data from 1368 prospectively enrolled outpatients from 33 centres in India from the EMBARC India Registry were included for the cluster analysis. Among these patients (mean age 54 years, 60% men) six clusters were identified. Our clusters were driven by patient demographics (age and sex), BMI (median BMI 21.48), aetiology of Bronchiectasis (Idiopathic 22.9%, post TB 34.3%, Post infectious 21.3%, ABPA 9.9%) Lung function (mean FEV1 53.36%, FVC 63.71%). Patients in the six clusters showed significant differences in terms of quality of life, exacerbations and hospitalisations. This is in complete contrast to the European cohort where four clusters were identified driven by the presence of chronic infection with Pseudomonas Aeruginosa or other pathogens and daily sputum production. Conclusion: Hence this is the first effort to define discrete phenotypes of Bronchiectasis patients in an Asian population. Identification of six clinical phenotypes in Bronchiectasis could favour focused treatments in future interventional studies designed to alter the natural history of the disease.

Introduction and Methods: The European Multicenter Bronchiectasis Audit and Research Collaboration (EMBARC) network established across 23 European countries was extended to India to explore unique features of Non-cystic fibrosis Bronchiectasis in this sub-continent. 34 investigator sites located across different parts of India contributed to 2062 cases of Non-CF Bronchiectasis, of which post-tuberculosis lung disease was identified as the biggest risk factor contributing to 34.7% (N=717) cases. The aim of this study was to describe the unique features of Post-TB Bronchiectasis observed on HRCT in this Indian cohort. Results: The mean (± SD) age of the 717 cases of Post-TB Bronchiectasis was 54.9 ± 14 yrs with a M:F ratio of 60:40. The location of Bronchiectasis was 71% (67.7,74.3) in the upper lobes, 66% (62.5,69.5) in the middle lobe/lingula and 60% (56.4,63.6) in the lower lobes. The cystic type was the most common 56% (53.1,60.4), followed by cylindrical 46% (42.3,49.6) and varicose 8.9% (6.8,10.9). More than 43.8% had bilateral disease. 13.6% (11.3,16.3) of the cases presented with hemoptysis that required hospitalization. Sputum microbiological samples collected in 39.8% of the cases isolated Pseudomonas in 17.1% during stable disease and 18.9% during exacerbations, while Klebsiella was isolated in 4.5% and 16.0% of cases respectively. Myco TB was isolated in the sputum in 5% of cases. 39.5% of the subjects had FEV1/FVC values Conclusion: Post TB lung disease is the commonest cause for Non CF Bronchiectasis in India and presents with unique features that are distinct from those reported in the western world.