A presentation at the CHEST Annual Meeting in Boston, Massachusetts, highlighted interesting trends in real-world clinical practice for non-cystic fibrosis bronchiectasis (NCFBE). According to the study, most patients first sought care in an ambulatory setting and required specialist care from a pulmonologist or radiologist. In addition, the researchers found that patients with more severe lung function status at baseline had more lung function tests during follow-up and were more likely to have a hospitalization or emergency department (ED) visit during the follow-up period.
“Delays between symptom onset and diagnosis are common among patients with NCFBE,” said speaker Joseph Feliciano, PharmD, of Insmed Incorporated. “Knowledge of clinical trends in NCFBE presentation may help efforts to increase awareness of the disease among the most relevant healthcare providers, enabling earlier diagnosis and intervention. Understanding current patterns in clinical practice for patients with NCFBE may help target efforts aimed at reducing diagnostic delays and improving outcomes.”
The researchers gathered data from Optum’s Market Clarity Integrated Claims and Clinical Database on patients with NCFBE who were 12 years or older and had two or more outpatient claims with a bronchiectasis diagnosis 30 or more days apart, or one inpatient claim with a bronchiectasis diagnosis. The study excluded patients with cystic fibrosis. The sample included 912 patients with a mean age of 68 years (SD=13); most (65%) were female. Their mean (SD) Charlson Comorbidity Index score was 2.12 (1.78).
Notably, most patients had their first observed visit in an ambulatory private office setting (47.1%), followed by “other,” which included telehealth, and ambulatory facility outpatient setting (26.2%). It was relatively rare for patients to have their first observed visit in an inpatient setting (7.7%) or ED (2.5%). Regarding type of provider, 39.1% of patients saw a pulmonologist, 16.7% saw a health care provider labeled “other,” 16.2% saw a radiologist, 13.9% saw a provider whose specialty was unknown, and 11.8% saw a general practitioner. The most commonly used treatments were antibiotics (57.8%), oral corticosteroids (57.4%), short-acting beta agonists (55.4%), nebulizer (46.9%), and macrolides (43.9%).
The researchers categorized lung function status at baseline according to forced expiratory volume in one second (FEV1):
- Normal was FEV1 >80% predicted
- Mild was >50% and <80% predicted
- Moderate to severe was >30 to <50% predicted
- Very severe was <30% predicted
Over a 24- to 48-month follow-up period, patients who had moderate-to-severe or very severe lung function at baseline tended to receive more FEV1 assessments during follow-up, compared to those who had normal lung function at baseline. Those with moderate-to-severe lung function had a mean of 6.4 assessments, those with very severe function had a mean of 10.3 assessments, and those with normal function had a mean of 4.2 assessments. The researchers noted that a lower number of assessments in those with normal lung function may limit practitioners’ ability to monitor decline over time, which is an important factor in NCFBE management.
Finally, a higher proportion of patients with moderate-to-severe or very severe lung function at baseline had all-cause hospitalizations or ED visits during the follow-up period.
Reference
Sadikot R, Feliciano J, Odo NU, et al. Non-cystic fibrosis bronchiectasis clinical practice in the real-world setting [Rapid Fire Presentation: Challenges in Bronchiectasis]. Presented at the CHEST Annual Meeting; October 6-9, 2024; Boston, Massachusetts.
