Bronchiectasis in India

results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry

Raja Dhar, Sheetu Singh, Deepak Talwar, Murali Mohan, Surya Kant Tripathi, Rajesh Swarnakar, Sonali Trivedi, Srinivas Rajagopala, George D'Souza, Arjun Padmanabhan, Archana Baburao, Padukudru Anand Mahesh, Babaji Ghewade, Girija Nair, Aditya Jindal, Gayathri Devi H. Jayadevappa, Honney Sawhney, Kripesh Ranjan Sarmah, Kaushik Saha, Suresh Anantharaj & 44 others Arjun Khanna, Samir Gami, Arti Shah, Arpan Shah, Naveen Dutt, Himanshu Garg, Sunil Vyas, Kummannoor Venugopal, Rajendra Prasad, Naveed M. Aleemuddin, Saurabh Karmakar, Virendra Singh, Surinder Kumar Jindal, Shubham Sharma, Deepak Prajapat, Sagar Chandrashekaria, Melissa J. McDonnell, Aditi Mishra, Robert Rutherford, Ramanathan Palaniappan Ramanathan, Pieter C. Goeminne, Preethi Vasudev, Katerina Dimakou, Megan L. Crichton, Biiligere Siddaiah Jayaraj, Rahul Kungwani, Akanksha Das, Mehneet Sawhney, Eva Polverino, Antoni Torres, Nayan Sri Gulecha, Michal Shteinberg, Anthony De Soyza, Anshul Mangala, Palak Shah, Nishant Kumar Chauhan, Nikita Jajodia, Ashutosh Singhal, Sakshi Batra, Ashfaq Hasan, Sneha Limaye, Sundeep Salvi, Stefano Aliberti, James D. Chalmers

Research output: Contribution to journalArticle

1 Citation (Scopus)
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Abstract

Background: Bronchiectasis is a common but neglected chronic lung disease. Most epidemiological data are limited to cohorts from Europe and the USA, with few data from low-income and middle-income countries. We therefore aimed to describe the characteristics, severity of disease, microbiology, and treatment of patients with bronchiectasis in India.

Methods: The Indian bronchiectasis registry is a multicentre, prospective, observational cohort study. Adult patients (≥18 years) with CT-confirmed bronchiectasis were enrolled from 31 centres across India. Patients with bronchiectasis due to cystic fibrosis or traction bronchiectasis associated with another respiratory disorder were excluded. Data were collected at baseline (recruitment) with follow-up visits taking place once per year. Comprehensive clinical data were collected through the European Multicentre Bronchiectasis Audit and Research Collaboration registry platform. Underlying aetiology of bronchiectasis, as well as treatment and risk factors for bronchiectasis were analysed in the Indian bronchiectasis registry. Comparisons of demographics were made with published European and US registries, and quality of care was benchmarked against the 2017 European Respiratory Society guidelines.

Findings: From June 1, 2015, to Sept 1, 2017, 2195 patients were enrolled. Marked differences were observed between India, Europe, and the USA. Patients in India were younger (median age 56 years [IQR 41–66] vs the European and US registries; p<0·0001]) and more likely to be men (1249 [56·9%] of 2195). Previous tuberculosis (780 [35·5%] of 2195) was the most frequent underlying cause of bronchiectasis and Pseudomonas aeruginosa was the most common organism in sputum culture (301 [13·7%]) in India. Risk factors for exacerbations included being of the male sex (adjusted incidence rate ratio 1·17, 95% CI 1·03–1·32; p=0·015), P aeruginosa infection (1·29, 1·10–1·50; p=0·001), a history of pulmonary tuberculosis (1·20, 1·07–1·34; p=0·002), modified Medical Research Council Dyspnoea score (1·32, 1·25–1·39; p<0·0001), daily sputum production (1·16, 1·03–1·30; p=0·013), and radiological severity of disease (1·03, 1·01–1·04; p<0·0001). Low adherence to guideline-recommended care was observed; only 388 patients were tested for allergic bronchopulmonary aspergillosis and 82 patients had been tested for immunoglobulins.

Interpretation: Patients with bronchiectasis in India have more severe disease and have distinct characteristics from those reported in other countries. This study provides a benchmark to improve quality of care for patients with bronchiectasis in India. Funding: EU/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis Consortium, European Respiratory Society, and the British Lung Foundation.

Original languageEnglish
Pages (from-to)e1269-e1279
Number of pages11
JournalThe Lancet Global Health
Volume7
Issue number9
Early online dateAug 2019
DOIs
Publication statusPublished - 1 Sep 2019

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Bronchiectasis
Registries
India
Research
Quality of Health Care
Sputum
Cystic Fibrosis
Allergic Bronchopulmonary Aspergillosis
Guideline Adherence
Benchmarking
Drug Industry
Traction
Microbiology
Pulmonary Tuberculosis
Dyspnea
Pseudomonas aeruginosa
Lung Diseases
Observational Studies
Biomedical Research
Immunoglobulins

Cite this

Dhar, Raja ; Singh, Sheetu ; Talwar, Deepak ; Mohan, Murali ; Tripathi, Surya Kant ; Swarnakar, Rajesh ; Trivedi, Sonali ; Rajagopala, Srinivas ; D'Souza, George ; Padmanabhan, Arjun ; Baburao, Archana ; Mahesh, Padukudru Anand ; Ghewade, Babaji ; Nair, Girija ; Jindal, Aditya ; Jayadevappa, Gayathri Devi H. ; Sawhney, Honney ; Sarmah, Kripesh Ranjan ; Saha, Kaushik ; Anantharaj, Suresh ; Khanna, Arjun ; Gami, Samir ; Shah, Arti ; Shah, Arpan ; Dutt, Naveen ; Garg, Himanshu ; Vyas, Sunil ; Venugopal, Kummannoor ; Prasad, Rajendra ; Aleemuddin, Naveed M. ; Karmakar, Saurabh ; Singh, Virendra ; Jindal, Surinder Kumar ; Sharma, Shubham ; Prajapat, Deepak ; Chandrashekaria, Sagar ; McDonnell, Melissa J. ; Mishra, Aditi ; Rutherford, Robert ; Ramanathan, Ramanathan Palaniappan ; Goeminne, Pieter C. ; Vasudev, Preethi ; Dimakou, Katerina ; Crichton, Megan L. ; Jayaraj, Biiligere Siddaiah ; Kungwani, Rahul ; Das, Akanksha ; Sawhney, Mehneet ; Polverino, Eva ; Torres, Antoni ; Gulecha, Nayan Sri ; Shteinberg, Michal ; De Soyza, Anthony ; Mangala, Anshul ; Shah, Palak ; Chauhan, Nishant Kumar ; Jajodia, Nikita ; Singhal, Ashutosh ; Batra, Sakshi ; Hasan, Ashfaq ; Limaye, Sneha ; Salvi, Sundeep ; Aliberti, Stefano ; Chalmers, James D. / Bronchiectasis in India : results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry. In: The Lancet Global Health. 2019 ; Vol. 7, No. 9. pp. e1269-e1279.
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title = "Bronchiectasis in India: results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry",
abstract = "Background: Bronchiectasis is a common but neglected chronic lung disease. Most epidemiological data are limited to cohorts from Europe and the USA, with few data from low-income and middle-income countries. We therefore aimed to describe the characteristics, severity of disease, microbiology, and treatment of patients with bronchiectasis in India.Methods: The Indian bronchiectasis registry is a multicentre, prospective, observational cohort study. Adult patients (≥18 years) with CT-confirmed bronchiectasis were enrolled from 31 centres across India. Patients with bronchiectasis due to cystic fibrosis or traction bronchiectasis associated with another respiratory disorder were excluded. Data were collected at baseline (recruitment) with follow-up visits taking place once per year. Comprehensive clinical data were collected through the European Multicentre Bronchiectasis Audit and Research Collaboration registry platform. Underlying aetiology of bronchiectasis, as well as treatment and risk factors for bronchiectasis were analysed in the Indian bronchiectasis registry. Comparisons of demographics were made with published European and US registries, and quality of care was benchmarked against the 2017 European Respiratory Society guidelines.Findings: From June 1, 2015, to Sept 1, 2017, 2195 patients were enrolled. Marked differences were observed between India, Europe, and the USA. Patients in India were younger (median age 56 years [IQR 41–66] vs the European and US registries; p<0·0001]) and more likely to be men (1249 [56·9{\%}] of 2195). Previous tuberculosis (780 [35·5{\%}] of 2195) was the most frequent underlying cause of bronchiectasis and Pseudomonas aeruginosa was the most common organism in sputum culture (301 [13·7{\%}]) in India. Risk factors for exacerbations included being of the male sex (adjusted incidence rate ratio 1·17, 95{\%} CI 1·03–1·32; p=0·015), P aeruginosa infection (1·29, 1·10–1·50; p=0·001), a history of pulmonary tuberculosis (1·20, 1·07–1·34; p=0·002), modified Medical Research Council Dyspnoea score (1·32, 1·25–1·39; p<0·0001), daily sputum production (1·16, 1·03–1·30; p=0·013), and radiological severity of disease (1·03, 1·01–1·04; p<0·0001). Low adherence to guideline-recommended care was observed; only 388 patients were tested for allergic bronchopulmonary aspergillosis and 82 patients had been tested for immunoglobulins.Interpretation: Patients with bronchiectasis in India have more severe disease and have distinct characteristics from those reported in other countries. This study provides a benchmark to improve quality of care for patients with bronchiectasis in India. Funding: EU/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis Consortium, European Respiratory Society, and the British Lung Foundation.",
author = "Raja Dhar and Sheetu Singh and Deepak Talwar and Murali Mohan and Tripathi, {Surya Kant} and Rajesh Swarnakar and Sonali Trivedi and Srinivas Rajagopala and George D'Souza and Arjun Padmanabhan and Archana Baburao and Mahesh, {Padukudru Anand} and Babaji Ghewade and Girija Nair and Aditya Jindal and Jayadevappa, {Gayathri Devi H.} and Honney Sawhney and Sarmah, {Kripesh Ranjan} and Kaushik Saha and Suresh Anantharaj and Arjun Khanna and Samir Gami and Arti Shah and Arpan Shah and Naveen Dutt and Himanshu Garg and Sunil Vyas and Kummannoor Venugopal and Rajendra Prasad and Aleemuddin, {Naveed M.} and Saurabh Karmakar and Virendra Singh and Jindal, {Surinder Kumar} and Shubham Sharma and Deepak Prajapat and Sagar Chandrashekaria and McDonnell, {Melissa J.} and Aditi Mishra and Robert Rutherford and Ramanathan, {Ramanathan Palaniappan} and Goeminne, {Pieter C.} and Preethi Vasudev and Katerina Dimakou and Crichton, {Megan L.} and Jayaraj, {Biiligere Siddaiah} and Rahul Kungwani and Akanksha Das and Mehneet Sawhney and Eva Polverino and Antoni Torres and Gulecha, {Nayan Sri} and Michal Shteinberg and {De Soyza}, Anthony and Anshul Mangala and Palak Shah and Chauhan, {Nishant Kumar} and Nikita Jajodia and Ashutosh Singhal and Sakshi Batra and Ashfaq Hasan and Sneha Limaye and Sundeep Salvi and Stefano Aliberti and Chalmers, {James D.}",
note = "EU/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis Consortium, European Respiratory Society, and the British Lung Foundation.",
year = "2019",
month = "9",
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doi = "10.1016/S2214-109X(19)30327-4",
language = "English",
volume = "7",
pages = "e1269--e1279",
journal = "The Lancet Global Health",
issn = "2214-109X",
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Dhar, R, Singh, S, Talwar, D, Mohan, M, Tripathi, SK, Swarnakar, R, Trivedi, S, Rajagopala, S, D'Souza, G, Padmanabhan, A, Baburao, A, Mahesh, PA, Ghewade, B, Nair, G, Jindal, A, Jayadevappa, GDH, Sawhney, H, Sarmah, KR, Saha, K, Anantharaj, S, Khanna, A, Gami, S, Shah, A, Shah, A, Dutt, N, Garg, H, Vyas, S, Venugopal, K, Prasad, R, Aleemuddin, NM, Karmakar, S, Singh, V, Jindal, SK, Sharma, S, Prajapat, D, Chandrashekaria, S, McDonnell, MJ, Mishra, A, Rutherford, R, Ramanathan, RP, Goeminne, PC, Vasudev, P, Dimakou, K, Crichton, ML, Jayaraj, BS, Kungwani, R, Das, A, Sawhney, M, Polverino, E, Torres, A, Gulecha, NS, Shteinberg, M, De Soyza, A, Mangala, A, Shah, P, Chauhan, NK, Jajodia, N, Singhal, A, Batra, S, Hasan, A, Limaye, S, Salvi, S, Aliberti, S & Chalmers, JD 2019, 'Bronchiectasis in India: results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry', The Lancet Global Health, vol. 7, no. 9, pp. e1269-e1279. https://doi.org/10.1016/S2214-109X(19)30327-4

Bronchiectasis in India : results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry. / Dhar, Raja; Singh, Sheetu; Talwar, Deepak; Mohan, Murali; Tripathi, Surya Kant; Swarnakar, Rajesh; Trivedi, Sonali; Rajagopala, Srinivas; D'Souza, George; Padmanabhan, Arjun; Baburao, Archana; Mahesh, Padukudru Anand; Ghewade, Babaji; Nair, Girija; Jindal, Aditya; Jayadevappa, Gayathri Devi H.; Sawhney, Honney; Sarmah, Kripesh Ranjan; Saha, Kaushik; Anantharaj, Suresh; Khanna, Arjun; Gami, Samir; Shah, Arti; Shah, Arpan; Dutt, Naveen; Garg, Himanshu; Vyas, Sunil; Venugopal, Kummannoor; Prasad, Rajendra; Aleemuddin, Naveed M.; Karmakar, Saurabh; Singh, Virendra; Jindal, Surinder Kumar; Sharma, Shubham; Prajapat, Deepak; Chandrashekaria, Sagar; McDonnell, Melissa J.; Mishra, Aditi; Rutherford, Robert; Ramanathan, Ramanathan Palaniappan; Goeminne, Pieter C.; Vasudev, Preethi; Dimakou, Katerina; Crichton, Megan L.; Jayaraj, Biiligere Siddaiah; Kungwani, Rahul; Das, Akanksha; Sawhney, Mehneet; Polverino, Eva; Torres, Antoni; Gulecha, Nayan Sri; Shteinberg, Michal; De Soyza, Anthony; Mangala, Anshul; Shah, Palak; Chauhan, Nishant Kumar; Jajodia, Nikita; Singhal, Ashutosh; Batra, Sakshi; Hasan, Ashfaq; Limaye, Sneha; Salvi, Sundeep; Aliberti, Stefano; Chalmers, James D. (Lead / Corresponding author).

In: The Lancet Global Health, Vol. 7, No. 9, 01.09.2019, p. e1269-e1279.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Bronchiectasis in India

T2 - results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry

AU - Dhar, Raja

AU - Singh, Sheetu

AU - Talwar, Deepak

AU - Mohan, Murali

AU - Tripathi, Surya Kant

AU - Swarnakar, Rajesh

AU - Trivedi, Sonali

AU - Rajagopala, Srinivas

AU - D'Souza, George

AU - Padmanabhan, Arjun

AU - Baburao, Archana

AU - Mahesh, Padukudru Anand

AU - Ghewade, Babaji

AU - Nair, Girija

AU - Jindal, Aditya

AU - Jayadevappa, Gayathri Devi H.

AU - Sawhney, Honney

AU - Sarmah, Kripesh Ranjan

AU - Saha, Kaushik

AU - Anantharaj, Suresh

AU - Khanna, Arjun

AU - Gami, Samir

AU - Shah, Arti

AU - Shah, Arpan

AU - Dutt, Naveen

AU - Garg, Himanshu

AU - Vyas, Sunil

AU - Venugopal, Kummannoor

AU - Prasad, Rajendra

AU - Aleemuddin, Naveed M.

AU - Karmakar, Saurabh

AU - Singh, Virendra

AU - Jindal, Surinder Kumar

AU - Sharma, Shubham

AU - Prajapat, Deepak

AU - Chandrashekaria, Sagar

AU - McDonnell, Melissa J.

AU - Mishra, Aditi

AU - Rutherford, Robert

AU - Ramanathan, Ramanathan Palaniappan

AU - Goeminne, Pieter C.

AU - Vasudev, Preethi

AU - Dimakou, Katerina

AU - Crichton, Megan L.

AU - Jayaraj, Biiligere Siddaiah

AU - Kungwani, Rahul

AU - Das, Akanksha

AU - Sawhney, Mehneet

AU - Polverino, Eva

AU - Torres, Antoni

AU - Gulecha, Nayan Sri

AU - Shteinberg, Michal

AU - De Soyza, Anthony

AU - Mangala, Anshul

AU - Shah, Palak

AU - Chauhan, Nishant Kumar

AU - Jajodia, Nikita

AU - Singhal, Ashutosh

AU - Batra, Sakshi

AU - Hasan, Ashfaq

AU - Limaye, Sneha

AU - Salvi, Sundeep

AU - Aliberti, Stefano

AU - Chalmers, James D.

N1 - EU/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis Consortium, European Respiratory Society, and the British Lung Foundation.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Background: Bronchiectasis is a common but neglected chronic lung disease. Most epidemiological data are limited to cohorts from Europe and the USA, with few data from low-income and middle-income countries. We therefore aimed to describe the characteristics, severity of disease, microbiology, and treatment of patients with bronchiectasis in India.Methods: The Indian bronchiectasis registry is a multicentre, prospective, observational cohort study. Adult patients (≥18 years) with CT-confirmed bronchiectasis were enrolled from 31 centres across India. Patients with bronchiectasis due to cystic fibrosis or traction bronchiectasis associated with another respiratory disorder were excluded. Data were collected at baseline (recruitment) with follow-up visits taking place once per year. Comprehensive clinical data were collected through the European Multicentre Bronchiectasis Audit and Research Collaboration registry platform. Underlying aetiology of bronchiectasis, as well as treatment and risk factors for bronchiectasis were analysed in the Indian bronchiectasis registry. Comparisons of demographics were made with published European and US registries, and quality of care was benchmarked against the 2017 European Respiratory Society guidelines.Findings: From June 1, 2015, to Sept 1, 2017, 2195 patients were enrolled. Marked differences were observed between India, Europe, and the USA. Patients in India were younger (median age 56 years [IQR 41–66] vs the European and US registries; p<0·0001]) and more likely to be men (1249 [56·9%] of 2195). Previous tuberculosis (780 [35·5%] of 2195) was the most frequent underlying cause of bronchiectasis and Pseudomonas aeruginosa was the most common organism in sputum culture (301 [13·7%]) in India. Risk factors for exacerbations included being of the male sex (adjusted incidence rate ratio 1·17, 95% CI 1·03–1·32; p=0·015), P aeruginosa infection (1·29, 1·10–1·50; p=0·001), a history of pulmonary tuberculosis (1·20, 1·07–1·34; p=0·002), modified Medical Research Council Dyspnoea score (1·32, 1·25–1·39; p<0·0001), daily sputum production (1·16, 1·03–1·30; p=0·013), and radiological severity of disease (1·03, 1·01–1·04; p<0·0001). Low adherence to guideline-recommended care was observed; only 388 patients were tested for allergic bronchopulmonary aspergillosis and 82 patients had been tested for immunoglobulins.Interpretation: Patients with bronchiectasis in India have more severe disease and have distinct characteristics from those reported in other countries. This study provides a benchmark to improve quality of care for patients with bronchiectasis in India. Funding: EU/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis Consortium, European Respiratory Society, and the British Lung Foundation.

AB - Background: Bronchiectasis is a common but neglected chronic lung disease. Most epidemiological data are limited to cohorts from Europe and the USA, with few data from low-income and middle-income countries. We therefore aimed to describe the characteristics, severity of disease, microbiology, and treatment of patients with bronchiectasis in India.Methods: The Indian bronchiectasis registry is a multicentre, prospective, observational cohort study. Adult patients (≥18 years) with CT-confirmed bronchiectasis were enrolled from 31 centres across India. Patients with bronchiectasis due to cystic fibrosis or traction bronchiectasis associated with another respiratory disorder were excluded. Data were collected at baseline (recruitment) with follow-up visits taking place once per year. Comprehensive clinical data were collected through the European Multicentre Bronchiectasis Audit and Research Collaboration registry platform. Underlying aetiology of bronchiectasis, as well as treatment and risk factors for bronchiectasis were analysed in the Indian bronchiectasis registry. Comparisons of demographics were made with published European and US registries, and quality of care was benchmarked against the 2017 European Respiratory Society guidelines.Findings: From June 1, 2015, to Sept 1, 2017, 2195 patients were enrolled. Marked differences were observed between India, Europe, and the USA. Patients in India were younger (median age 56 years [IQR 41–66] vs the European and US registries; p<0·0001]) and more likely to be men (1249 [56·9%] of 2195). Previous tuberculosis (780 [35·5%] of 2195) was the most frequent underlying cause of bronchiectasis and Pseudomonas aeruginosa was the most common organism in sputum culture (301 [13·7%]) in India. Risk factors for exacerbations included being of the male sex (adjusted incidence rate ratio 1·17, 95% CI 1·03–1·32; p=0·015), P aeruginosa infection (1·29, 1·10–1·50; p=0·001), a history of pulmonary tuberculosis (1·20, 1·07–1·34; p=0·002), modified Medical Research Council Dyspnoea score (1·32, 1·25–1·39; p<0·0001), daily sputum production (1·16, 1·03–1·30; p=0·013), and radiological severity of disease (1·03, 1·01–1·04; p<0·0001). Low adherence to guideline-recommended care was observed; only 388 patients were tested for allergic bronchopulmonary aspergillosis and 82 patients had been tested for immunoglobulins.Interpretation: Patients with bronchiectasis in India have more severe disease and have distinct characteristics from those reported in other countries. This study provides a benchmark to improve quality of care for patients with bronchiectasis in India. Funding: EU/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis Consortium, European Respiratory Society, and the British Lung Foundation.

UR - http://www.scopus.com/inward/record.url?scp=85070214098&partnerID=8YFLogxK

U2 - 10.1016/S2214-109X(19)30327-4

DO - 10.1016/S2214-109X(19)30327-4

M3 - Article

VL - 7

SP - e1269-e1279

JO - The Lancet Global Health

JF - The Lancet Global Health

SN - 2214-109X

IS - 9

ER -