During the first year of the COVID-19 pandemic, the US bronchiectasis exacerbation rate was significantly lower than it was during the prior year, according to study findings published in the Annals of the American Thoracic Society.
Bronchiectasis exacerbation etiology is uncertain although potential triggers include environmental exposures, eosinophilic and neutrophilic inflammation, and bacterial and viral infections. During the COVID-19 pandemic, social distancing and lockdowns reduced the frequency and number of interpersonal interactions, resulting in a reduction in the circulation of respiratory viruses. Because of that, investigators sought to characterize the effect of the COVID-19 pandemic on the frequency of bronchiectasis exacerbations among commercially insured US patients.
The investigators conducted a retrospective observational cohort study using deidentified data from Optum’s Clinformatics Data Mart database of US health insurance claims data. Diagnostic codes were used to identify patients and covered dependents with bronchiectasis who were at least 18 years of age. A comparison of the bronchiectasis exacerbation rates before and during the COVID-19 pandemic was the primary endpoint.
The main cohort, which excluded patients with asthma and COPD, included 905 patients from time-window 1 (March 2018-February 2020) and 954 patients from time-window 2 (March 2019-February 2021). The sensitivity cohort, which did not exclude patients with asthma and COPD, included 2164 patients from time-window 1 and 2141 patients from time-window 2. Nearly all patients in both cohorts (≈99.7%) had at least 2 bronchiectasis diagnosis codes at least 30 days apart.
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The results of our study show that patients with bronchiectasis in the US experienced reductions in exacerbation rates during the first year of the pandemic compared with the 12-month period immediately prior.
Demographically, fewer patients in the database with bronchiectasis were from the Northern US and a more were from the Southwestern and Southeastern US. The main cohort included more women (77% in time-window 1 and 75% in time-window 2) and patients’ median (interquartile range) age was 75 (69-81) years in time-window 1 and 76 (69-82) years in time-window 2. The sensitivity cohort demographics were similar.
During the study period, bronchiectasis treatments included oral and intravenous antibiotics; inhaled, oral, and intravenous corticosteroids; and inhaled bronchodilators.
The investigators noted that among patients in the main cohort from time-window 1, there were no statistically significant changes in prescribed treatment between the first and second years. Among patients in the main cohort from time-window 2, statistically significant reductions were noted in prescribed intravenous corticosteroids; inhaled bronchodilators and corticosteroids; and oral macrolides, corticosteroids, and antibiotics.
For patients in the sensitivity cohort from time-window 1, significant reductions were noted for prescribed inhaled corticosteroids only. For patients in the sensitivity cohort from time-window 2, there were statistically significant reductions in all prescribed treatment medications.
Comparing the year before the pandemic with the first year of the pandemic, the investigators found the median number of bronchiectasis exacerbations per patient before the pandemic was 1 compared with zero during the pandemic, a significant decrease (P <.01). Additionally, more patients (57%) experienced zero exacerbations during the first year of the pandemic compared with the prior year (24%) (McNemar’s chi-square=122.56; P <.01).
Study limitations include studying 2 separate 2-year windows instead of a single 3-year window, residual confounding, and bias toward a White population.
“The results of our study show that patients with bronchiectasis in the US experienced reductions in exacerbation rates during the first year of the pandemic compared with the 12-month period immediately prior,” the investigators concluded.
Disclosure: This research was supported by AstraZeneca (Cambridge, United Kingdom).
