Background: Increased frequency of bronchiectasis exacerbations (BEx) accelerates disease progression. International guidelines aim to prevent BEx and delay disease progression. Prior studies using insurance databases likely underestimated BEx burden. Objective: To understand the distribution of patient clinical characteristics according to bronchiectasis disease severity and BEx frequency. Methods: Data from adults with non–cystic fibrosis bronchiectasis (NCFBE) who were enrolled in the BRR (2008-Mar 2020) were analyzed for baseline demographic and clinical characteristics using descriptive statistics. Patients were stratified into groups based on BEx frequency (0 to ≥4) in the 2 years (y) prior to enrollment. Results: Of 2950 patients (mean age, 65.4 y; diagnosis duration, 7.7 y), 58.2% had ≥1 BEx and 13.7% had ≥4. The ≥4 BEx group had the most patients with severe disease (51%; mean BSI = 8.9) and underlying comorbidities, such as chronic obstructive pulmonary disease (22.8%) or asthma (42.1%), as well as the highest rates of moderate to severe airway obstruction (76%), fatigue (53.1%), hemoptysis (28.4%), wheezing (45.9%), maintenance macrolide use (22.9%), or P aeruginosa infection (36.2%), and hospitalization (37.1%). Conclusions: The findings demonstrate significant disease burden in patients with frequent exacerbations and highlight the importance of exacerbation prevention.

Background: BEx are important events in the natural history of bronchiectasis. Objective: This study explored the longitudinal association between the number of BEx at baseline and over 4 y of follow-up. Methods: We used data from adult patients with non–cystic fibrosis bronchiectasis (NCFBE) and 4 y of follow-up (2008-2020) in the BRR database. Analyses were performed at 3 time points in 2-y intervals: baseline (≤2 y prior to enrollment), Y1+2, and Y3+4. Patients were stratified by number of BEx at each time point: 0, 1, or ≥2. Results: A total of 520 patients (mean age, 65.2 y; 84% female; BE duration, 8.0 y) were included. At baseline 41%, 23%, and 36% of patients had 0, 1, and ≥2 BEx, respectively. The groups differed (P<0.05) in age, BE duration, nontuberculous mycobacteria and P aeruginosa status, FEV1, and asthma. A statistically significant association was found between BEx at baseline and Y1+2, baseline and Y3+4, and Y1+2 and Y3+4 (P<0.0001) (Figure); a greater number of baseline BEx was associated with a greater number of follow-up BEx; the group with ≥2 BEx at baseline had the most BEx over the 4-y follow-up. Conclusion: A greater number of exacerbations at baseline was positively associated with a greater number of exacerbations at follow-up, highlighting exacerbation prevention as an important unmet need in patients with NCFBE.

Rationale: Non-cystic fibrosis bronchiectasis (NCFB) is characterized by dilated bronchi, poor mucus clearance and susceptibility to bacterial infection. Pseudomonas aeruginosa (PA) is one of the most frequently isolated pathogens in patients with NCFB. The purpose of this study was to evaluate the association between presence of PA and disease severity in patients within the US Bronchiectasis and Nontuberculous mycobacteria (NTM) Research Registry (BRR). Methods: Baseline US BRR data from adult patients with NCFB collected between 2008 and 2018 was used for this study. The presence of PA was defined as one or more positive PA cultures within two years prior to enrollment. Modified Bronchiectasis Severity Index (m-BSI) and modified FACED (m-FACED) were computed to evaluate severity of bronchiectasis. Unadjusted and multivariable multinomial regression models were used to assess the association between presence of PA and severity of bronchiectasis. Results: Average age of the study participants (n = 1831) was 63.7 years (SD = 14.1), 91.5% white, and 78.8% female. Presence of PA was identified in 25.4% of the patients. Patients with presence of PA had significantly lower mean pre-bronchodilator FEV1% predicted compared to those without PA (62.8% vs. 73.7%, p < .0001). In multivariate analyses, patients with presence of PA had significantly greater odds for having high (ORadj = 6.15 (95%CI:3.98-9.50) and intermediate (ORadj = 2.06 (95%CI:1.37-3.09) severity vs. low severity on m-BSI. Conclusion: The presence of PA is common in patients with NCFB within the Bronchiectasis and NTM Research Registry. Severity of bronchiectasis is significantly greater in patients with PA which emphasizes high burden of the disease.

Nutrition and Markers of Disease Severity in Patients With Bronchiectasis Katherine A. Despotes, MD1 Radmila Choate, PhD, MPH2,3 Doreen Addrizzo-Harris, MD4 Timothy R. Aksamit, MD5 Alan Barker, MD6 Ashwin Basavaraj, MD4 Charles L. Daley, MD7 Edward Eden, MD8 Angela DiMango, MD9 Kevin Fennelly, MD10 Julie Philley, MD11 Margaret M. Johnson, MD12 Pamela J. McShane, MD13 Mark L. Metersky, MD14 Anne E. O’Donnell, MD15 Kenneth N. Olivier, MD, MPH10 Matthias A. Salathe, MD16 Andreas Schmid, MD16 Byron Thomashow, MD9 Gregory Tino, MD17 Kevin L. Winthrop, MD, MPH6,18 Michael R. Knowles, MD1 Mary Leigh Anne Daniels, MD, MPH1 Peadar G. Noone, MD1 Original Research

SESSION TITLE: Chest Infections 2 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Mycobacterium tuberculosis is the leading infectious cause of death from any single organism in adults. More than two billion people are estimated to be infected with TB worldwide. It usually involves the lungs, but can also present as extrapulmonary TB. (approximately two thirds of people will have pulmonary tuberculosis while less than a third of immuncompetent individuals will have extrapulmonary tuberculosis alone) The diagnosis of extrapulmonary TB can be difficult and often requires a high index of suspicion. We present a case of TB that manifested as a tubercular retropharyngeal abscess. CASE PRESENTATION: A 67 year old female from Vietnam presented complaining of 2 months of worsening posterior neck pain, which progressed to dysphagia to liquids and solids and was associated with weight loss. At presentation she denied any fevers, chills, chest pain, cough, hemoptysis or any other symptoms. On examination she was afebrile, well appearing with normal vital signs, normal pulmonary, cardiac and abdominal examination; but she had left anterior neck tenderness to palpation. Laboratory data was unrevealing. She underwent MRI of the cervical spine to evaluate her neck pain, and the MRI showed C1-C2 retropharyngeal abscess with osteomyelitis of C2 with considerable bone destruction. A Barium swallow study showed a fistulous connection to the retropharygeal space. A CT scan of the chest showed multiple bilateral pulmonary nodules. She underwent incision and drainage of the retropharyngeal abscess with significant improvement in symptoms . Abscess drainage grew Klebsiella pneumoniae. The smear was negative for AFB, but the culture became positive after 21 days for pan-susceptible Mycobacterium Tuberculosis. Gastric drainage and sputum AFB were negative. She was started on high dose steroids and anti-tuberculous treatment after the culture from the retropharyngeal abscess became positive. A PEG tube was placed for nutrition and administration of medications. After 6 weeks of anti-tuberculous treatment and steroid therapy,a fluoroscopy swallow study was repeated which showed resolution of the previously seen fistula and a significant decrease in the size of the retropharyngeal abscess. She completed one year of anti-tuberculous treatment for osteomyelitis related to Mtb. DISCUSSION: Tubercular retropharyngeal abscess is an uncommon cause of neck pain and dysphagia and is an atypical presentation of tuberculosis. It requires a detailed history and physical exam in addition to a high index of suspicion. Early recognition and treatment is essential to prevent serious complications from mediastinitis, airway obstruction, up to paraplegia that could be caused from severe osteomyelitis. CONCLUSIONS: TB is a disease with high prevalence worldwide. TB can have many different clinical presentations and is important to keep it in consideration as differential diagnosis in suspicious cases. Reference #1: Colmenero JD, Jiménez-Mejías ME, Reguera JM, Palomino-Nicás J, Ruiz-Mesa JD, Márquez-Rivas J, et al. Tuberculous vertebral osteomyelitis in the new millennium: Still a diagnostic and therapeutic challenge. Eur J Clin Microbiol Infect Dis. 2004;23:477–83 Reference #2: Marques PM, Spratley JE, Leal LM, Cardoso E, Santos M. Parapharyngeal abscess in children: Five year retrospective study. Braz J Otorhinolaryngol. 2009;75:826–30 Reference #3: Harkani A, Hassani R, Ziad T, Aderdour L, Nouri H, Rochdi Y, et al. Retropharyngeal abscess in adults: Five cases reports and review of the literature. Scientific World Journal. 2011;11:1623–9. DISCLOSURES: no disclosure on file for Ashkin David; No relevant relationships by Megan Ninneman, source=Web Response No relevant relationships by Yoslay Perez, source=Web Response No relevant relationships by Rene Rico, source=Web Response No relevant relationships by Andreas Schmid, source=Web Response