Bronchiectasis Evaluation of Adjunctive Therapy with Erdosteine and Nebulized Amikacin for Chronic Cough and Healthcare Outcomes (BEAT-COUGH Study): A Two-Centre Experience

Background: Chronic cough is a major determinant of impaired quality of life and recurrent exacerbations in bronchiectasis. The BEAT-COUGH Study evaluated the effectiveness of adjunctive oral erdosteine plus nebulized amikacin during acute exacerbation and long-term maintenance in patients with non-cystic fibrosis bronchiectasis. Methods: The BEAT-COUGH Study was a prospective, two-center observational study (VCC:37/2023) with a 52-week follow-up. A total of 164 adults with HRCT-confirmed bronchiectasis, a Modified Reiff Score > 10, acute exacerbation, and positive sputum microbiology were enrolled. Eighty-two patients received standard care alone, and 82 received standard care plus oral erdosteine and nebulized amikacin (250 mg twice daily during exacerbation, followed by once daily during maintenance). A total of 144 patients completed maintenance follow-up. Cough severity was assessed using a 100 mm Visual Analog Scale (VAS), with VAS < 20 mm defining a satisfactory response. Secondary outcomes included exacerbation frequency, duration, time to first exacerbation, exacerbation-free days, sputum rheology, microbiology, hospitalization, antibiotic use, and healthcare costs. Results: Adjunctive therapy produced significantly higher satisfactory cough responses during both acute exacerbation and maintenance (both p < 0.001). Combination therapy reduced the duration of mild, moderate, and severe exacerbations by 39.97%, 37.30%, and 30.26%, respectively (all p < 0.0001); prolonged time to first exacerbation and exacerbation-free days (all p < 0.0001); and reduced moderate and severe exacerbations while increasing the proportion of exacerbation-free patients (p = 0.00019). Significant improvements were observed in sputum viscosity and clearance (90.3% vs. 19.4%), sputum volume (94.4% vs. 13.9%), and sputum color (91.7% vs. 13.9%) (all p < 0.0001). Conclusions: Adjunctive erdosteine plus nebulized amikacin significantly improved cough control, sputum rheology, exacerbation outcomes, and healthcare utilization, supporting its role as an effective adjunctive strategy for exacerbation-prone non-cystic fibrosis bronchiectasis.