Inhaled corticosteroids (ICS) are frequently prescribed for bronchiectasis, even when guidelines do not recommend their use, according to a recent study published in Thorax.The European Bronchiectasis Registry (Embarc) analyzed data from over 19,000 individuals across 31 countries.
The research, led by Dr. Jennifer Pollock from the University of Dundee, found that ICS were used in more than 52% of bronchiectasis cases.Notably, for 9,715 patients, ICS were not indicated according to European guidelines, as they did not have asthma, COPD, or allergic bronchopulmonary aspergillosis. Despite this, a third of these patients received ICS.
Patients who used ICS generally had more severe bronchiectasis. This included poorer lung function, increased sputum production, and more frequent exacerbations. They also required more concomitant medications, such as antibiotics and bronchodilators, and had a higher mortality rate. Though, the study authors noted that it remains unclear whether ICS were prescribed due to the severity of the disease or if the medication negatively impacted the disease’s progression and contributed to increased mortality.
A specific subgroup of patients treated with ICS without a clear indication appeared to benefit. Those with elevated eosinophil counts experienced substantially fewer exacerbations when using ICS,a benefit not observed in patients with normal eosinophil levels. This suggests that ICS therapy might be beneficial for the eosinophilic phenotype of bronchiectasis. Conversely, for other phenotypes, the side effects of corticosteroids could perhaps cause harm. Further large,randomized controlled studies are needed to confirm these findings.
Source: Pollock J et al.Thorax 2025; 80: 358-368; doi: 10.1136/thorax-2024-221825
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