Bronchiectasis in Italy: an analysis of the EMBARC registry

BackgroundBronchiectasis is a complex diseasewith geographical variability in its presentation and management.Despite thegrowingcontributionof international registries, real-worlddataon the Italian bronchiectasis population remain limited. The objective of the present study was to describe the demographic, clinical, microbiological, functional and treatment characteristics of Italian patientswith bronchiectasisandtocomparethemwiththoseofpatientsfromotherSouthernEuropeancountries. MethodsThis was a secondary analysis of adults from18 Italian centres included in the European MulticentreBronchiectasisAuditandResearchCollaboration(EMBARC)registry,withcomparisonsmadeto patients inSpain,Greece,Portugal,Turkey, Israel andMalta(SouthernEuropeancountries).Demographics, comorbidities,exacerbationhistory,spirometry,microbiologyandtreatmentpatternswereevaluated. ResultsAmong1657Italianpatients, themajoritywere female (70.5%)withamedianageof65years, withhigh rates of idiopathicbronchiectasis (55.4%) andpreserved lung function.Comparedwithother SouthernEuropeancountries (n=2638), Italianpatientshadlowerdiseaseseverity(medianBronchiectasis Severity Index: 6 versus 7; p<0.001), less frequent isolation of Pseudomonas aeruginosa, and lower prevalenceofdailysputumproductionandpurulence, despite identicalqualityof life(medianQualityof LifeQuestionnaire-BronchiectasisRespiratorySymptomScore: 70.4 inbothgroups). Treatment patterns differed,withloweruseof inhaledantibiotics (1.1%versus13.1%)andmacrolides (6.0%versus14.3%), butmorewidespreaduseofairwayclearance(48.4%versus35.9%)amongpatientsfromItalyversusother SouthernEuropeancountries. Conclusions These findings may reflect earlier referral, diagnostic preferences or structural differences in care delivery in Italy compared with other Southern European countries. This work lays the foundation for tailored national strategies and future longitudinal studies. The largest bronchiectasis cohort ever studied in Italy reveals unique clinical traits and highlights key differences from other Southern European countries, and provides real-world data to shape better care models and guide future research.