Exacerbations and inhaled corticosteroids in bronchiectasis patients

Introduction: Inhaled corticosteroids (ICS) are effective in exacerbations prevention in patients with obstructive lung diseases. They were also related to increased risk of pneumonia. The aim of this study was to evaluate the effect on exacerbations of inhaled corticosteroids in a bronchiectasis population before a specialized study at a bronchiectasis clinic. Methods: Retrospective cohort study from Centro Hospitalar de Leiria (Portugal). Sample was divided into patients on previous ICS treatment (G1) and ICS naive group (G0). General demographics, microbiologic profile, lung function, comorbidities and exacerbation rate before specialized study were compared among groups (cut-off 3 or more exacerbations based on Bronchiectasis Severity Index [BSI]). Central tendency measures, chi-square, Fisher Exact test and T-Test were used. Statistical significance was determined to p Results: Sample size 115 patients: G1 66 patients (48.5% females, mean age 63.6±16.2 years); G2 49 patients (44.9% females, mean age 57.2±19.9 years), p=0.09/p=0.70 for age/sex). Before bronchiectasis study, 24.2% patients had 3 or more exacerbations in G1 vs 10.2% in G0 (p=0.050). Excluding asthma (n=18, 100% on ICS), G1 had statistically significant more exacerbations than G0 (p=0.016). Controlling for COPD, Pseudomonas aeruginosa or other microorganisms and eosinophils (n=94) there were no differences between groups. G1 had worse lung function compared to G0 (FEV1 1.5L vs 2.2L p=0.003; FVC 2.5L vs 3.2L p=0.008). G1 were classified as “severe” by BSI more often (28.8% vs 6.1%, p=0.008). Conclusions: ICS were related to more exacerbations and to a worse lung function. Cause-effect or absence of exacerbation protection may explain these results.