Initiating NIV in bronchiectasis - Is it a sign of poor life expectancy?

Introduction: In COPD NIV is associated with poor 5-year survival. However, in bronchiectasis the impact of NIV on survival is unknown. Aim: To determine survival of non-cystic fibrosis bronchiectasis patients after initiation of NIV. Methods: Data were retrospectively collected for 142 patients with a primary diagnosis of bronchiectasis initiated on NIV at the Royal Brompton Hospital between 01/1997 to 02/2020. 11 patients were excluded (lack of available information on NIV or receiving a lung transplant within 2 years of initiating NIV). Data were analysed using univariate, logistic regression and survival analysis in SPSS. Results: Of the 131 included cases 59.5% were female and the mean (SD) age at initiation of NIV was 68 (15) years. 77% were non-smokers and 21% ex-smokers. Mean (SD) FEV1 (L) was 0.77 (0.31) and 79% had FEV1/FVC<0.7 with mean (SD) capillary blood gas CO2 of 7.68 (1.17) Kpa. CT Chest showed bronchiectasis in >3 lobes in 84% (n=106/127) with 27.6% also demonstrating evidence of emphysema. 4.6% had associated neuromuscular weakness or kyphoscoliosis and 6.1% were obese. 74% (n=89/120) had cultured Pseudomonas aeruginosa. Smoking status, obesity, obstructive spirometry, emphysema on CT, number of lobes involved on CT and P. aeruginosa culture were not associated with survival. Mean survival time (months) post-NIV was 149 (95% CI 124 – 174) and 61% of cases were alive at 5 years. Only age was associated with survival time (p=0.010) with a mean survival time of 179 (95% CI 133 – 225), 150 (95% CI 116 - 185) and 73 (95% CI 50 – 95) for those aged <=60, 61-80 and >80 years, respectively. Conclusion: Patients with bronchiectasis requiring NIV do not have poor life expectancy.