The Relationship Between Symptoms, Exacerbations And Treatment Response in Bronchiectasis

Background: Bronchiectasis guidelines regard treatment to prevent exacerbation and relieve symptom as separate objective. We hypothesized that patients with greater symptoms would be at higher risk of exacerbation and therefore a treatment aimed at reducing symptoms would reduce exacerbations in highly symptomatic patients. Methods: An observational cohort of 333 patients are analyzed. Symptoms were either modelled as a continuous variable or patients were classified as high, moderate and low symptom burden (>70, 40-70 and Results: In the observational cohort symptoms were a significant predictor of future exacerbations (rate ratio [RR] 1.10, 95% confidence interval [CI] 1.03-1.17, P=0.005). Patients with high symptom scores had higher exacerbation rates (RR 1.74, 95% CI 1.12-2.72, P=0.01) over 12 months follow-up compared to those with low symptoms. Inhaled mannitol improved the time to first exacerbation (hazard ratio 0.56; 95% CI 0.40-0.77; P Conclusions: Highly symptomatic patients are at increased risk of exacerbations and have exacerbation benefit with inhaled mannitol.