Use of proton pump inhibitors, pre-existing heart failure symptoms, and severe bronchiectasis are some of the factors that contribute to the development of exacerbations requiring hospitalization among bronchiectasis patients, according to a study published in the journal Respiratory Research.
In the United States, 16.5 hospitalizations per 100,000 people are caused by bronchiectasis exacerbations. It is not yet clear what causes these acute episodes, and their incidence and severity vary among patients.
Patients older than 60 and women had higher hospitalization rates. Additionally, advanced phases of disease and high Bronchiectasis Severity Index are factors associated with longer hospitalization stays.
However, little is known about risk factors and patient profiles that might lead to bronchiectasis exacerbations requiring hospital admission.
In the study, “Factors associated with hospitalization in bronchiectasis exacerbations: a one-year follow-up study,” researchers at University of Valencia in collaboration with the Centro de Investigación Biomédica en Red-Enfermedades Respiratorias in Madrid, evaluated the characteristics, usual treatments, bronchiectasis severity scores, and history of prior exacerbations in 319 patients who were followed for up to one year.
All clinical information was collected from 2011 to 2015 from the records of two tertiary care university hospitals belonging to the Spanish National Health Service.
A total of 162 patients were hospitalized within the one-year follow-up period. About 82% of the patients experienced worsening difficulty in breathing, 37% presented new findings in chest radiographic evaluation, 35% experienced abnormally rapid breathing, 31% had fever, and 28% experienced respiratory failure.
The hospitalized patients were older and presented more concomitant chronic diseases, including diabetes, chronic obstructive pulmonary disease (COPD), heart failure, and myocardial infarction. These patients also had more regular treatments and presented increased levels of Pseudomonas aeruginosa bacteria colonization.
Evaluating patient characteristics and clinical features allowed researchers to identify five independent risk factors and one protective factor for predicting hospital admission among bronchiectasis patients.
Similar to other studies, age and bronchiectasis severity scores were associated with an increased risk for hospitalization.
Researchers also found that patients with symptoms of heart failure had 5.47 times higher risk of hospitalization due to bronchiectasis exacerbations.
The occurrence of previous hospitalizations associated with bronchiectasis increased the risk by 2.63 times for a new hospitalization, a feature shared with other respiratory illnesses.
The team also found that patients receiving treatment with proton pump inhibitors (PPIs) had a 2.85 times higher risk of hospitalization. This trend has been reported in previous studies and is believed to be associated with community-acquired pneumonia, but the underlying mechanism is unclear.
One hypothesis is that PPIs may alter the gut microbiome and promote the accumulation of commensal microorganisms in the upper gastrointestinal tract. However, further studies are required to confirm this hypothesis.
In contrast, researchers observed that patients who received the pneumococcal vaccine had a risk reduction of nearly 60% for future hospitalizations due to bronchiectasis exacerbations.
“Our study identified a group of vulnerable BE [bronchiectasis exacerbations] patients likely to develop exacerbations requiring hospitalization during a one-year follow-up period,” the researchers wrote. “These BE patients would probably benefit from a more extensive follow-up, high quality specialized care, intensified treatment, vaccine implementation and even novel therapies in order to improve prognosis.”
The team highlighted that further studies on the risk factors associated with hospital admission and on the role of PPIs are needed, and that these may “help to devise preventive strategies for improving the course of the disease and reducing both morbidity and the economic burden.”