Clinical heterogeneity of bronchiectasis exacerbations: a multicentre real-world study

Background and aim Exacerbations are critical events in the natural history of bronchiectasis. While an international definition has been proposed for clinical trials by an EMBARC/BRR task force, the clinical presentation of exacerbations varies considerably among patients. The aim of our study was to assess the clinical heterogeneity of signs and symptoms of bronchiectasis exacerbations in a real-world setting. Methods This was a multicentre cross-sectional study involving nine bronchiectasis centres in Italy. Consecutive adults with bronchiectasis reported symptoms during stable-state and during typical exacerbations over the past 2 years. Symptom frequency, their impact on daily life, and concordance with the 2017 EMBARC/BRR definition were assessed overall and by comorbidity/infection subgroups. Results We enrolled 367 patients (79% female; median age 65 years). During exacerbations, cough (87%), increased sputum volume (81%), and purulence (77%) predominated and clustered with fatigue (72%) and exertional dyspnoea (64%). Patients ranked cough and sputum changes as highest impact. Overall, 85% of typical exacerbations met EMBARC/BRR criteria; exacerbation events that were not concordant with EMBARC/BRR criteria were more frequent in patients with NTM-PD (p=0.004). Patients with asthma/COPD as comorbidity reported more dyspnoea and wheezing, patients with chronic P. aeruginosa infection more frequently reported haemoptysis and nocturnal dyspnoea. Conclusions Exacerbations present with distinct symptom patterns across subgroups, and about one in seven typical patient reported events do not meet consensus criteria, underscoring the need for more sensitive patient-centred definitions.

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Journal
ERJ Open Research
Published
2026-08-20
DOI
https://doi.org/10.1183/23120541.00106-2026
Primary Topic
Cystic Fibrosis Research Advances
Type
article
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article

Clinical heterogeneity of bronchiectasis exacerbations: a multicentre real-world study

Angela Tramontano, Claudia Duranti, Martina Bonifazi, Valentina Conio et al.
ERJ Open Research
Cystic Fibrosis Research Advances
article

Clinical heterogeneity of bronchiectasis exacerbations: a multicentre real-world study

Angela Tramontano, Claudia Duranti, Martina Bonifazi, Valentina Conio, Michela Salvemini, Mariangela Valentina Puci, Raffaele Campisi, Mattia Nigro, Paola Scarano, Anna Stainer, Giovanna Elisiana Carpagnano, Edoardo Simonetta, Andrea Gramegna, Salvatore Battaglia, Antonio Voza, Giovanni Sotgiu, Veronica Polelli, Francesco Amati, Paola Faverio, Stefano Aliberti, Vittoria Comellini, Alessandro De Angelis, Paolo Palange, Marianna Cicchetti, Martina Lo Casto, Martina Marchello, Mariarosaria Vulpi, Emanuele Toni, James D. Chalmers, Claudia Crimi, Lucrezia Pisanu, Donato Lacedonia, Matteo Bonini, Giacomo Barzaghi, Francesco Blasi
article en

Abstract

Background and aim Exacerbations are critical events in the natural history of bronchiectasis. While an international definition has been proposed for clinical trials by an EMBARC/BRR task force, the clinical presentation of exacerbations varies considerably among patients. The aim of our study was to assess the clinical heterogeneity of signs and symptoms of bronchiectasis exacerbations in a real-world setting. Methods This was a multicentre cross-sectional study involving nine bronchiectasis centres in Italy. Consecutive adults with bronchiectasis reported symptoms during stable-state and during typical exacerbations over the past 2 years. Symptom frequency, their impact on daily life, and concordance with the 2017 EMBARC/BRR definition were assessed overall and by comorbidity/infection subgroups. Results We enrolled 367 patients (79% female; median age 65 years). During exacerbations, cough (87%), increased sputum volume (81%), and purulence (77%) predominated and clustered with fatigue (72%) and exertional dyspnoea (64%). Patients ranked cough and sputum changes as highest impact. Overall, 85% of typical exacerbations met EMBARC/BRR criteria; exacerbation events that were not concordant with EMBARC/BRR criteria were more frequent in patients with NTM-PD (p=0.004). Patients with asthma/COPD as comorbidity reported more dyspnoea and wheezing, patients with chronic P. aeruginosa infection more frequently reported haemoptysis and nocturnal dyspnoea. Conclusions Exacerbations present with distinct symptom patterns across subgroups, and about one in seven typical patient reported events do not meet consensus criteria, underscoring the need for more sensitive patient-centred definitions.

ERJ Open Research
University of Foggia (IT), Marche Polytechnic University (IT), Humanitas University (IT), University of Sassari (IT), University of Dundee (GB), University of Pavia (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Istituto delle Scienze Neurologiche di Bologna (IT), Policlinico Universitario di Catania (IT), University of Palermo (AR), IRCCS Humanitas Research Hospital (IT), University of Bari Aldo Moro (IT), University of Milano-Bicocca (IT), Sapienza University of Rome (IT), University of Palermo (IT)
Ministero della Salute
Openalex Percentile: Top 10%
Cystic Fibrosis Research Advances
DOIOpen Access PDFOpenAlex
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