Abstract Bronchiectasis treatment varies significantly in clinical practice, and important information gaps remain regarding the use and patterns of inhaled antibiotics for these patients in the US. These medications have not been approved by regulatory agencies for this indication. We aimed to characterize the epidemiology of non-CF bronchiectasis—including prevalence, incidence, exacerbation rates, and inhaled antibiotic prescribing patterns—using a national managed care claims database. Methods Using a retrospective cohort design, we identified adults with bronchiectasis in the MarketScan’s Commercial, Medicare, and Medicaid databases (2014-2023). Bronchiectasis was defined as ≥ 2 ICD codes in outpatient/inpatient claims, more than 30 days apart (time-zero). Exacerbation was defined as either (1) initiation of a new qualifying systemic antibiotic in the outpatient setting or (2) an inpatient claim for pneumonia, lower respiratory infection, or bronchiectasis exacerbation. A treatment episode was defined as a ≥ 28-day supply of an inhaled antibiotic without prior use during the observation period; episodes concluded when no refill occurred within 45 days after supply exhaustion. Prevalence and incidence were estimated for each calendar year among beneficiaries with full coverage; annual estimates were fitted in a Poisson model to compute temporal changes. Weighted analyses estimated annual occurrence and exacerbation rates for the Commercial and Medicare populations. Results From 2014-2023, 90,480 patients with bronchiectasis were identified (mean age 66.2 years, SD 14.6; 64.9% female). Only 12.7% of Medicaid cases received ICD codes for bronchiectasis from pulmonologists, compared to 57% in Commercial and 55.2% in Medicare at time-zero. At time-zero, 2.2% had a history of Pseudomonas infection and 4.4% of nontuberculous mycobacterial infection. In the Commercial and Medicare datasets, average prevalence was 99.4 per 100,000 population (annual increase +8.6%), incidence was 30.8 per 100,000 (stable trend), and mean exacerbation rate was 1.08 per person-year. In Medicaid, prevalence was lower (64.1 per 100,000) but grew faster (+13.5% annually), with an incidence of 18.3 per 100,000 and 0.74 exacerbations per person-year. Prevalence growth was higher before 2020 but slowed during the COVID-19 pandemic period (2020-2023), while exacerbation rates declined substantially across all datasets. A total of 1,285 new users of inhaled antibiotics were identified (mean treatment duration up to 187.5 days, SD 198.9): 343 received amikacin, 48 aztreonam, 53 colistin, 46 gentamicin, and 881 tobramycin, with 49 patients receiving more than one antibiotic class. Conclusions In this nationally representative U.S. analysis, bronchiectasis prevalence increased while exacerbation rates declined during the pandemic. Inhaled antibiotic use was uncommon and heterogeneous, primarily involving tobramycin and amikacin This abstract is funded by: American College of Chest Physicians (CHEST)
Rojas et al. (Fri,) studied this question.