Airway clearance management for bronchiectasis in China: a multicentre cross-sectional study from the Chinese bronchiectasis registry (BE-China)

Summary Background Airway clearance techniques (ACTs) are guideline-recommended in bronchiectasis, while contemporary patterns and determinants of ACTs adoption remain unclear in China. Methods A multicentre cross-sectional study was conducted using data from the BE-China cohort between 10 Jan 2020 and 31 Mar 2024. Clinical characteristics and prespecified ACT modalities were collected across 92 hospitals. Multivariable logistic regression identified important associations of ACTs utilization. Findings Among 9647 patients, 12.2% (1177) used regular ACTs at baseline, and regional heterogeneity in ACTs utilization was observed. Moreover, ACTs users exhibited prolonged disease duration, a higher proportion of severe disease, greater comorbidity, heavier cough and sputum burden, and more frequent pharmacological and ventilatory interventions. Variables associated with increased ACTs utilization included comorbid burden (OR 1.47, 1.28–1.70; p < 0.0001), daily sputum (OR 1.68, 1.33–2.10; p < 0.0001), expectorants usage (OR 3.19, 2.74–3.71; p < 0.0001), inhaled antibiotics (OR 2.04, 1.35–3.07; p=0.00065), macrolide therapy (OR 2.31, 1.78–2.99; p < 0.0001), other long-term oral antibiotics (OR 1.37, 1.13–1.66; p=0.0013), noninvasive ventilation requirement (OR 4.11, 3.14–5.39; p < 0.0001), and disease duration (per SD increase, OR 1.08, 1.01–1.15; p=0.027). Both BE-China and the similar European Bronchiectasis Registry (EMBARC) cohorts showed distinct etiological and comorbidity profiles, yet consistently revealed a higher medication burden among ACTs users. Interpretation In China, ACTs utilization is primarily concentrated among patients with bronchiectasis who have a heavier symptom burden and greater treatment intensity. Clinicians may leverage the identified associations to optimize adherence and guide phenotype-targeted ACTs implementation strategies, and these findings may serve as a reference for future research. Funding Noncommunicable Chronic Diseases-National Science and Technology Major Project, National Natural Science Foundation of China, Innovation Program of Shanghai Municipal Education Commission, Program of Shanghai Municipal Science and Technology Commission, Major Project of Guangzhou National Laboratory.