Phenotype Analysis of Chronic Bronchial Infection Patients on Inhaled Antibiotic Therapy: A Multicentre Retrospective Cohort Study in Spain (INBREATHING Study)

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Introduction: The clinical phenotype of chronic bronchial infection(CBI)patients may predict response to inhaled antibiotic(IA)therapy. Methods: A retrospective multicenter study in Spain included CBI patients treated with IA from 2018 to 2024. Baseline clinical, and radiological data were collected. Changes in exacerbations, symptoms, and treatment tolerance were assessed after one year. Phenotypes were identified and validated, and a predictive model for post-IA exacerbations was developed. Results: The cohort mainly included older males (55.2%) with bronchiectasis(BE)(77.8%) and COPD (39.6%). Colistin was the most prescribed IA (72.9%). Three phenotypes were identified:1)Preserved lung function(FEV₁93.9%), mostly females with BE;2)Moderately impaired lung function(FEV₁62.6%), with COPD and BE;3)Severely impaired lung function (FEV₁35.9%), olderCOPD patients with comorbidities. After one year, phenotype 3 had a higher exacerbation risk (63.8%), more side effects, and greater IA discontinuation(33%). Predictors of exacerbations included prior exacerbations(OR1.37), varicose/cystic BE(OR1.84), comorbidities (OR1.48), age(OR1.01), and phenotype 3(OR 2.36).A web application and nomogram were developed. Conclusions: Three clinical phenotypes of CBI were identified, with prognostic implications for IA response, and a new model was developed to predict post-IA exacerbations. erj;66/suppl_69/PA757/F1 F1 F1

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