Thorax

Inhaled corticosteroids widely used in bronchiectasis despite limited guideline support

July 31, 2025

Study details: A large, prospective cohort study from the European Bronchiectasis Registry (EMBARC) enrolled 19,324 adults with bronchiectasis (2015–2022) to assess inhaled corticosteroids (ICS) prescribing patterns and outcomes. Patients were stratified by ICS use at baseline, with subgroup analyses excluding those with asthma, chronic obstructive pulmonary disease (COPD), or allergic bronchopulmonary aspergillosis (ABPA). Clinical outcomes (exacerbations, hospitalizations, mortality) were tracked for up to 5 years, and the effect of elevated blood eosinophil counts on ICS response was evaluated.

Results: ICS were prescribed in 52.3% of patients overall, including 32.7% of patients without a guideline-based indication. Usage varied widely across countries (17%–85%). ICS users had more severe disease at baseline, with significantly worse spirometry, higher Bronchiectasis Severity Index scores, and more frequent exacerbations (p<0.0001). Despite this, ICS use was not associated with lower rates of exacerbation or hospitalization. Importantly, a subset of ICS users with elevated eosinophil counts experienced a significant reduction in exacerbation frequency (relative risk, 0.70; 95% confidence interval, 0.59–0.84, p<0.001), suggesting an eosinophilic treatment-responsive phenotype.

Clinical impact: ICS may be overused in bronchiectasis, according to current guidelines. Elevated blood eosinophils may help identify patients who may benefit, supporting a more personalized treatment approach.

Source:

Pollock J, et al. (2025, May 20). Thorax. Use of inhaled corticosteroids in bronchiectasis: data from the European Bronchiectasis Registry (EMBARC). https://pubmed.ncbi.nlm.nih.gov/40122611/