Impact of respiratory physiotherapy on the number of exacerbations and hospital admissions in patients with CBI reciving nebulized antibiotics: results of a multicenter retrospective study (INBREATHING).

Background: The impact of respiratory physiotherapy (RP) on mitigating exacerbations and minimizing hospital admissions during stable phases in patients with chronic bronchial infection (CBI) receiving inhaled antibiotics (IA) remains uncertain. <bold>Aim:</bold> To evaluate variations in exacerbation frequency and hospital admissions among CBI patients undergoing IA based on adherence to regular RP. Methods: A retrospective observational case-control study across 8 centers in Spain, examined IA treatment initiation from January 2018 to December 2022. Of 219 patients, 64 individuals practicing RP were propensity score-matched with 64 controls, based on age, type of bronchiectasis, and COPD diagnosis. Data on age, sex, underlying pathology, microorganisms isolated, IA type, and exacerbations/hospital frequency were collected for the 12 months pre and post initiation of IA and RP. Group comparisons utilized t.test or chi-squared test, with a Poisson mixed-effects model inflated to zero employed for analyzing exacerbations and hospitalizations. Results: Among the participants, 53.9% were male, with a mean age of 70 [60.8;79.0] years. COPD was diagnosed in 41.4%, and 85.9% had bronchiectasis. Pseudomonas Aeruginosa was detected in 75% of patients, and Colistin was the most frequently prescribed AI (77.3%). Patients who were under regular RP exhibited a more significant reduction in exacerbations compared to those who did not, with a risk ratio (95% CI) of 0.60 (0.37 to 0.99; p= 0.04). A similar trend was observed for hospitalizations, with a risk ratio (95% CI) of 0.03 (0.13 to 1.06; p= 0.06). <bold>Conclusions:</bold> Regular RP was associated with a significant reduction in exacerbations and hospital admissions for patients with CBI undergoing IA treatment.