Inhaled Corticosteroid Therapy in Bronchiectasis is Associated with All-Cause Mortality: A Prospective Cohort Study

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Kjell EJ Håkansson,1 Katrine Fjaellegaard,2,3 Andrea Browatzki,4 Melda Dönmez Sin,1 Charlotte Suppli Ulrik1,5 1Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark; 2Department of Respiratory Medicine, Zealand University Hospital Næstved, Næstved, Denmark; 3Institute of Regional Health Research, University Southern Denmark, Odense, Denmark; 4Department of Respiratory Medicine, North Zealand Hospital, Hillerød, Denmark; 5Institute of Clinical Medicine, University of Copenhagen, Copenhagen, DenmarkCorrespondence: Kjell EJ HåkanssonRespiratory Research Unit 237, Copenhagen University Hospital - Hvidovre, Kettegård Allé 30, 2650, Hvidovre, DenmarkEmail kjell@kjell.dkBackground and Objective: Prescribing inhaled corticosteroids (ICS) for bronchiectasis (BE) in the absence of obstructive lung disease is controversial. Studies investigating ICS therapy and impact on morbidity and mortality in BE are sparse.Methods: This study comprises all patients with BE managed at respiratory outpatient clinics at two university hospitals in the Capital Region of Denmark 2014– 2015. Baseline data were obtained from patient medical records, and patients were followed until April 2020.Results: Out of 264 patients, 122 (46%) were prescribed ICS with no demographic differences between users/non-users of ICS. Among patients prescribed ICS, 21% did not have a concomitant diagnosis of asthma or COPD. Patients prescribed ICS had lower lung function (median FEV1 65.2 vs 80.9%pred, p< 0.001) and a higher symptom burden in terms of cough (p 0.028), sputum production (p < 0.001) and dyspnea (p < 0.001). Pseudomonas-positive sputum cultures were more common in ICS-treated patients (6.5 vs 20%, p 0.010), as were previous severe exacerbations (41% vs 21%, p < 0.001). In terms of mortality, high-dose ICS use was associated with increased mortality in multivariable Cox regression adjusted for age, sex, FEV1 and concomitant asthma/COPD (HR 4.93 [95% CI 1.73– 14.0], p 0.003).Conclusion: In this cohort, close to one out of five patients with BE were prescribed ICS despite having no concomitant diagnosis of asthma or COPD. Overall, ICS treatment was associated with higher morbidity and mortality, though causation is difficult to establish.Keywords: follow-up cohort, descriptive study, all-cause mortality, ICS, non-cystic fibrosis bronchiectasis

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