Bronchiectasis

PURPOSE: Advanced age is widely believed to be a risk factor for acute exacerbations in patients with bronchiectasis. However, few data exist supporting this association.

METHODS: Data were obtained from a medical claims database containing information from >30 US health plans with a combined membership of >10 million lives annually. Study subjects consisted of all patients aged [greater than or equal to] 18 years with diagnoses of bronchiectasis between July 1998 and June 2002 and continuous medical coverage between July 2002 and June 2003 ("follow-up"); patients with cystic fibrosis were excluded. Study subjects were stratified based on age (<65 vs [greater than or equal to] 65 years). Acute exacerbations were defined to consist of respiratory hospitalizations and respiratory-related outpatient encounters with subsequent receipt of antibiotic therapy, and were identified during the one-year period of follow-up. Bivariate analyses were undertaken to examine the relationship between risk of acute exacerbations and age; statistical comparisons were performed using a chi-square test.

RESULTS: A total of 667 persons were identified who met study entrance criteria (age <65 years, n = 490; age [greater than or equal to] 65 years, n = 177). Mean ([+ or -] SD) age among those <65 years was 52 ([+ or -] 10); among those [greater than or equal to] 65 years, it was 76 ([+ or -] 8). During the one-year follow-up period, the percentage of patients experiencing one or more acute exacerbations did not differ by age (32.9% for age <65 years vs. 32.8% for age [greater than or equal to] 65 years, p=0.98). The risks of respiratory hospitalization (9.2% vs. 10.7% respectively, p=0.55) and respiratory-related outpatient encounters with subsequent receipt of antibiotic therapy (29.2% vs. 27.1%, p=0.60) also did not differ across age groups.

CONCLUSION: Risk of acute exacerbations among patients with bronchiectasis does not differ by age.

CLINICAL IMPLICATIONS: Our study suggests that age is not important in predicting the risk of acute exacerbations in patients with bronchiectasis.

DISCLOSURE: Derek Weycker, Grant monies (from industry related sources) Funding for this research was provided by Chiron BioPharmaceuticals to Policy Analysis Inc. (PAI). an independent contract research organization.

Derek Weycker PhD * John Edelsberg MD Gerry Oster PhD Gregory Tino MD Policy Analysis Inc. (PAl), Brookline, MA

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group