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Original Research |

Pharmacotherapy for non-cystic fibrosis bronchiectasis: results from an NTM Info & Research patient survey and the Bronchiectasis and NTM Research Registry

E. Henkle; T.R. Aksamit; A.F. Barker; J.R. Curtis; C.L. Daley; M.L. Daniels; A. DiMango; E. Eden; K. Fennelly; D.E. Griffith; M. Johnson; M.R. Knowles; A. Leitman; P. Leitman; E. Malanga; M.L. Metersky; P.G. Noone; A.E. O'Donnell; K.N. Olivier; D. Prieto; M. Salathe; B. Thomashow; G. Tino; G. Turino; S. Wisclenny; K.L. Winthrop
Author and Funding Information

Sponsors/grants- The Bronchiectasis and NTM Research Registry was funded by the COPD Foundation and, in part (KNO), by the Intramural Research Program of the NHLBI NIH.

Guarantor statement- EH takes responsibility for the content of the manuscript, including the data and analysis.

Author contributions - EH had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. EH drafted the manuscript. All other co-authors contributed substantially to the study design, data analysis and interpretation, and the writing of the manuscript.

Conflict of Interest Statement

TRA has participated in clinical trials sponsored by Bayer, Aradigm, and Insmed but has not received any personal or research support.

AFB is a consultant and PI for clinic research study for Bayer and consultant to Grifols.

CLD received research support from Insmed.

DEG has received support as a consultant for Aradigm/Grifols and has received grant support from Insmed.

MLM has acted as a consultant for Insmed and Aradigm and received clinical trial support (to his institution) from Aradigm and Bayer.

PDN has served as a consultant to and received clinical trial support from Bayer.

AEO is a PI / received grant support for clinical trials for Aradigm, Bayer, and Insmed and consultant for Bayer, Novartis, and Xellia Pharmaceuticals

KNO has been the PI of a Cooperative Research and Development Agreement (CRADA) between NIAID and Insmed, Inc and between NHLBI and Matinas BioPharma. He has been an educational speaker at a Bayer sponsored symposium.

MS has received consultant fees from Insmed and Raptor Pharmaceuticals and research support from Aradigm and Insmed for clinical trials.

GTino has been a consultant for Aradigm /Grifols and Bayer.

KLW has served as a consultant to Bayer and has received grant support from Insmed.

No conflicts:

EH, JLC, MLD, AD, EE, KF, MJ, MRK, AL, PL, EM, DP, BT, GTurino, and SW have no conflicts.

1OHSU-PSU School of Public Health, Portland, OR

2Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, MN

3Department of Pulmonology, OHSU School of Medicine, Portland, OR

4University of Alabama at Birmingham, Birmingham AL

5Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, CO

6University of North Carolina at Chapel Hill, Chapel Hill, NC

7Columbia College of Physicians and Surgeons, Center for Chest Disease, New York, NY

8Icahn School of Medicine, Mt Sinai West and Mt Sinai St Luke’s Hospitals, Mt Sinai, NY

9National Heart Lung and Blood Institute, NIH, Bethesda, MD

10University of Texas at Tyler, Tyler, TX

11Mayo Clinic Florida, Pulmonary and Critical Care, Jacksonville, FL

12NTM Info & Research, Coral Gables, FL

13COPD Foundation, Miami, FL

14UConn Health, Farmington, CT

15Georgetown University Medical Center, Washington, DC

16Pulmonary Clinical Medicine Section, National Heart Lung and Blood Institute, NIH, Bethesda, MD

17University of Miami Miller School of Medicine, Miami, FL

18University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

19Department of Infectious Disease, OHSU School of Medicine, Portland, OR

Corresponding author: Emily Henkle, PhD, MPH 3181 SW Sam Jackson Park Road Mailcode GH104 Portland, OR 97239.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.04.167
Text Size: A A A
Published online

Abstract

Purpose  Non-cystic fibrosis bronchiectasis (“bronchiectasis”) is a chronic inflammatory lung disease often associated with nontuberculous mycobacterium (NTM) infection. Very little data exist to guide bronchiectasis management decisions. We sought to describe patterns of inhaled corticosteroid (ICS) and antibiotic therapy in the U.S.

Methods  We invited 2,000 patients through NTM Info & Research (NTMir) to complete an anonymous electronic survey. We separately queried baseline clinical and laboratory data from the U.S. Bronchiectasis and NTM Research Registry (BRR).

Results  Among 511 NTMir survey responders with bronchiectasis, median age was 67, 85 (17%) reported asthma, and 99 (19%) reported chronic obstructive pulmonary disease (COPD). History of ICS use was reported by 282 (55%), of whom 171 (61%) were treated >1 year and 150 (53%) were currently taking ICS. Fewer reported ever taking azithromycin for non-NTM bronchiectasis (203, 40%) or inhaled tobramycin (78, 15%). Median age of 1912 BRR patients was 69, 528 (28%) had asthma, and 360 (19%) had COPD. Among 740 lacking NTM, 314 (42%) were taking ICS at baseline. Among non-NTM patients taking ICS, only 178 (57%) had a concurrent diagnosis of COPD or asthma that could explain ICS use. Fewer were taking suppressive macrolides (96, 13%) and of the 70 (10%) taking inhaled suppressive antibiotics, 48 (68%) had chronic Pseudomonas aeruginosa infection.

Conclusions  In two national samples of bronchiectasis patients ICS use is common, with relatively few patients taking suppressive antibiotic therapies. Further research is needed to clarify the safety and effectiveness of these therapies in bronchiectasis patients.


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