Exacerbation Phenotypes and Treatment Patterns in Non-Cystic-Fibrosis Bronchiectasis: A Prospective Cohort Across Eighteen Months with Microbiological and Radiological Phenotyping

Dr. Kunal Kumar, Dr. Nasima Khatoon, Ajay Kumar

Bronchiectasis; Exacerbations; Pseudomonas Aeruginosa; Non-Tuberculous Mycobacteria; Macrolide Prophylaxis; Inhaled Antibiotics; Phenotyping.

Non-cystic-fibrosis bronchiectasis is increasingly recognised as a clinically important condition with substantial morbidity driven primarily by recurrent exacerbations. We followed 280 adults with established non-CF bronchiectasis prospectively for 18 months at a tertiary respiratory clinic, characterising exacerbation phenotypes, microbiological colonisation patterns, treatment intensities, and outcomes. The cohort showed clear phenotypic separation by exacerbation frequency: 102 patients (36.4%) were frequent exacerbators (≥3 events per year), 138 (49.3%) were infrequent exacerbators (1-2 events), and 40 (14.3%) experienced no exacerbations during follow-up. Chronic Pseudomonas aeruginosa colonisation, identified in 78 patients (27.9%) at baseline, was the strongest single predictor of frequent exacerbator status (adjusted OR 4.32). Radiological severity by Reiff score, FEV1 below 50% predicted, and NTM colonisation also independently predicted frequent exacerbator phenotype. Intensive treatment combining inhaled antibiotic, macrolide prophylaxis, and structured airway clearance was associated with substantially longer time to next exacerbation than standard care. The findings support phenotype-guided treatment intensification, with particular priority for patients with chronic Pseudomonas or severe radiological disease

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