Steady state signs and symptoms of bronchiectasis in an international multicentre cohort: the 4S study

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Although clinically significant bronchiectasis (CS-Bx) has been defined for clinical trials (Aliberti, Lancet RM 2021), its validation in real-life settings remains untested. The 4S (Steady State Signs and Symptoms) study is an international, multicentre, cross-sectional study across 15 centres in Europe and Asia, enrolling adults (≥18 years) with radiologically and clinically significant bronchiectasis per physician judgment. A stable-state symptom assessment classified patients into two groups: those adhering (Group A) or not adhering (Group B) to the 2021 definition. Among 729 patients (70.9% female; median age: 63 years), 43.1% had cough most days, 50.2% had sputum production, and 29.8% had purulent sputum. Other symptoms included fatigue (31.2%), weight loss (13.8%), night sweats (12.3%), nocturnal symptoms (11.0%), exertional dyspnoea (9.9%), breathlessness at rest (8.2%), fever (7.9%), and chest pain (7.9%). 35.5% had ≥3 respiratory infections in the past 2 years. 41.0% were in Group A. Among Group B, 13.7% had frequent cough, 21.4% had sputum production, and 18.4% had exacerbations. Group A had more males (33.8% vs 25.8%, P=0.021), higher disease severity (BSI 6 vs 5, P<0.001), more chronic Pseudomonas infections (29.3% vs 13.6%, P<0.001), and lower FEV1% (78 vs 86, P=0.009), but higher BMI (22.0 vs 21.4, P=0.016). They were more frequently treated with inhaled corticosteroids (36.2% vs 22.3%, P<0.001), long-acting beta agonists (50.2% vs 35.6%, P<0.001), and performed daily physiotherapy more often (35.8% vs 18.8%, P<0.001). CS-Bx patients show heterogeneous stable-state symptoms, often not meeting 2021 clinical trial criteria.

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