GORD/PPI and exacerbations in adults with bronchiectasis

Background: Adult patients with bronchiectasis have various aetiologies and comorbidities, which influence exacerbation rate. One of these factors is gastro-oesophageal reflux disease (GORD). For this subgroup a higher risk of exacerbations has been postulated. We analyzed data from the German bronchiectasis registry PROGNOSIS with regard to the impact of GORD and/or treatment with proton pump inhibitors (PPI) on the frequency of exacerbation. Methods: Out of 1000 consecutively recruited and validated datasets 346 subjects had self-reported GORD, GORD as an aetiology of bronchiectasis or received PPI treatment (GORD/PPI group). Fisher´s exact and Mann-Whitney-U test were used to assess differences between the GORD/PPI group and bronchiectasis without GORD/PPI. A multivariate model was used to evaluate the independent influence of GORD/PPI on ≥2 exacerbations and ≥1 hospitalisation in the previous year. Results: Median age was 65 vs 60 yrs (GORD/PPI vs. non-GORD/PPI; p<0.001); FEV1 % predicted was 66 vs 75% (p<0.001); 46 % had a BMI >25 kg/m2 compared to 32% (p<0.001); 40% had chronic Pseudomonas aeruginosa infection compared to 33% (p=0.026). Median annual exacerbation and hospitalisation rates were significantly higher in subjects with GORD/PPI (2 vs. 1 and 1 vs. 0, respectively; both p<0.001), as was breathlessness (median MRCD scale 3 vs. 2, p<0.001). After adjustment for common drivers of exacerbations GORD/PPI independently increased the risk of having ≥2 exacerbations (OR 1.5; 95% CI 1.1-2.0; p=0.01) and ≥1 hospitalisation (OR 1.7; 95% CI 1.3-2.4; p<0.001) remained. Conclusion: Self-reported GORD and/or PPI-use are independently associated with an increased risk of frequent exacerbation and hospitalisation.