OBJECTIVES: Non-Cystic Fibrosis Bronchiectasis (NCFB) is a chronic, progressive respiratory disorder characterized by irreversibly dilated airways and recurrent pulmonary infections. Concomitant infection with Pseudomonas aeruginosa is associated with greater lung function impairment, more frequent exacerbations, greater hospitalization risk and mortality. NCFB exacerbations are defined by an increase in daily symptoms including cough, sputum production, malaise, fatigue, and breathing difficulty. The burden of NCFB, among patients with P. aeruginosa, both chronically infected and with frequent acute exacerbations, has not been quantified.

METHODS: This retrospective longitudinal study utilized IQVIA’s PharMetrics Plus commercial claims database. Patients were 18-64yo with ≥2 outpatient claims, or ≥1 inpatient or Emergency Department claim for NCFB (ICD-10-CM: J47.XX or ICD-9-CM: 494.XX) and no cystic fibrosis diagnoses from 01/01/2010-06/30/2021. Patients were enrolled for 1 year after first NCFB diagnosis. P. aeruginosa patients had ≥1 claims for infection (ICD9: 041.7; ICD-10: B96-5) or pneumonia due to P. aeruginosa infection; patients with exacerbations had ≥1 NCFB hospitalization, ≥1 pneumonia (any), ≥2 exacerbations, or IV antibiotic treatment. Outcomes were patient characteristics and mean per patient annual healthcare resource utilization.

RESULTS: Among 36,283 NCFB patients, mean age was 53.3 ±9.9; 63.3% were female, 1,180 (3%) had exacerbations and P. aeruginosa, 18,074 (50%) had exacerbations/no P. aeruginosa, and 16,946 (47%) had neither (P. aeruginosa nor exacerbations).

Inpatient admissions were highest among exacerbations+P. aeruginosa patients (2.58±3.00; exacerbations/no P. aeruginosa: 1.18±1.70; neither: 0.11±0.45) as were outpatient encounters, including outpatient hospital visits (20.56±26.93; exacerbations/no P. aeruginosa: 10.97 ±15.85; neither: 6.28±10.47) and home healthcare visits (13.61±27.46; exacerbations/no P. aeruginosa: 4.10±15.74; neither: 1.51±9.68). Oral antibiotic prescriptions were also highest among exacerbations+P. aeruginosa patients (7.39±6.92; exacerbations/no P. aeruginosa: 4.65±5.22; neither: 3.07 ±4.15).

CONCLUSIONS: NCFB carries a large resource burden, particularly among patients with P. aeruginosa and exacerbations. It is possible that P. aeruginosa is under-coded, and some patients with exacerbations also have P. aeruginosa.