Objective sputum colour assessment and clinical outcomes in bronchiectasis: data from the European Bronchiectasis Registry (EMBARC)

Author:

Aliberti StefanoORCID,Ringshausen Felix C.ORCID,Dhar Raja,Haworth Charles S.,Loebinger Michael R.,Dimakou Katerina,Crichton Megan L.,De Soyza AnthonyORCID,Vendrell Montse,Burgel Pierre-RegisORCID,McDonnell MelissaORCID,Skrgat Sabina,Maiz Carro Luis,de Roux Andres,Sibila Oriol,Bossios ApostolosORCID,van der Eerden Menno,Kauppi Paula,Wilson Robert,Milenkovic Branislava,Menendez Rosario,Murris Marlene,Borekci Sermin,Munteanu Oxana,Obradovic Dusanka,Nowinski Adam,Amorim Adelina,Torres AntoniORCID,Lorent NatalieORCID,Van Braeckel EvaORCID,Altenburg Josje,Shoemark AmeliaORCID,Shteinberg MichalORCID,Boersma Wim,Goeminne Pieter C.,Elborn J. Stuart,Hill Adam T.,Welte TobiasORCID,Blasi Francesco,Polverino Eva,Chalmers James D.

Abstract

BackgroundA validated 4-point sputum colour chart can be used to objectively evaluate the levels of airway inflammation in bronchiectasis patients. In the European Bronchiectasis Registry (EMBARC), we tested whether sputum colour would be associated with disease severity and clinical outcomes.MethodsWe used a prospective, observational registry of adults with bronchiectasis conducted in 31 countries. Patients who did not produce spontaneous sputum were excluded from the analysis. The Murray sputum colour chart was used at baseline and at follow-up visits. Key outcomes were frequency of exacerbations, hospitalisations for severe exacerbations and mortality during up to 5-year follow-up.Results13 484 patients were included in the analysis. More purulent sputum was associated with lower forced expiratory volume in 1 s (FEV1), worse quality of life, greater bacterial infection and a higher bronchiectasis severity index. Sputum colour was strongly associated with the risk of future exacerbations during follow-up. Compared to patients with mucoid sputum (reference group), patients with mucopurulent sputum experienced significantly more exacerbations (incident rate ratio (IRR) 1.29, 95% CI 1.22–1.38; p<0.0001), while the rates were even higher for patients with purulent (IRR 1.55, 95% CI 1.44–1.67; p<0.0001) and severely purulent sputum (IRR 1.91, 95% CI 1.52–2.39; p<0.0001). Hospitalisations for severe exacerbations were also associated with increasing sputum colour with rate ratios, compared to patients with mucoid sputum, of 1.41 (95% CI 1.29–1.56; p<0.0001), 1.98 (95% CI 1.77–2.21; p<0.0001) and 3.05 (95% CI 2.25–4.14; p<0.0001) for mucopurulent, purulent and severely purulent sputum, respectively. Mortality was significantly increased with increasing sputum purulence, hazard ratio 1.12 (95% CI 1.01–1.24; p=0.027), for each increment in sputum purulence.ConclusionSputum colour is a simple marker of disease severity and future risk of exacerbations, severe exacerbations and mortality in patients with bronchiectasis.

Funder

Chief Scientist Office

Horizon 2020 Framework Programme

European Respiratory Society

Inhaled Antibiotic for Bronchiectasis and Cystic Fibrosis

Publisher

European Respiratory Society (ERS)

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