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Introduction: Clinical guidelines recommend airway clearance techniques (ACTs) in adults with bronchiectasis. There is a paucity of evidence about their clinical implementation, particularly in different healthcare systems. Multicentre registries can facilitate studying patterns and differences across countries. Methods: Outpatients with bronchiectasis were prospectively recruited to the multicentre European Bronchiectasis Registry EMBARC. Patient-reported ACTs were registered in 31 countries. Demographic, baseline health status, exacerbations, radiology, and treatments were recorded. Results: Data were collected between 2015 and 2018. 13,512 patients participated, mean (SD) age 64.2 (14.6) years old, 8,121 females (60.1%). Only 48.3% of the participants reported performing airway clearance regularly. The most commonly used techniques were active cycle of breathing techniques (ACBT) (26.8%) and postural drainage (6.0%). 21.2% of patients used one or more airway clearance devices. Flutter (8.9%), fixed positive expiratory pressure (PEP) (6.5%) and Acapella (4.4%) were the most commonly used ones. The vast majority of patients perform regular ACTs in Denmark (91.7%) and Finland (88.7%), compared to less than 10% of participants in Bulgaria, North Macedonia, Moldova, Romania, and Sweden. The primary reason for not doing airway clearance was that it was not required in the opinion of the clinicians (67.9%). Conclusions: Most patients with bronchiectasis do not routinely perform ACTs. Clinicians’ opinion is often that bronchiectasis patients do not require ACTs. Acknowledgments: EMBARC has received support from the EU/EFPIA Innovative Medicines Initiative Joint Undertaking iABC grant agreement no 115721.

Background: Randomized Trials in bronchiectasis may have been underpowered due to unexpectedly large “placebo effects”. We used a combination of meta-analysis and analysis of the European Bronchiectasis Registry (EMBARC) to quantify “placebo effects” in randomized trials in bronchiectasis Method: We searched electronic databases from 1990-2019, to identify double blind, randomized, placebo-controlled trials of drug treatment in bronchiectasis. We defined the “placebo effects” by comparing the outcomes at the end of placebo treatment and at baseline prior to treatment. EMBARC registry data were employed to model changes in exacerbation rate and quality of life (QoL) Result: 27 trials were included for meta-analysis (N=1739 placebo-treated patients). Placebo treatment was associated with significantly reduced exacerbation rate (mean difference [MD] -1.79, -2.03 to -1.56; p Conclusion: Placebo treatment was associated with improved QoL and reduced exacerbation in bronchiectasis. Enrolling patients with 1 or more exacerbation may be an optimal inclusion criteria

International audience; Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and resource use worldwide. The goal of this official American Thoracic Society (ATS)/European Respiratory Society (ERS) research statement is to describe evidence related to diagnosis, assessment and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management. Clinicians, researchers, and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarised, and then salient knowledge gaps were identified. Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulated via discussion and consensus. Great strides have been made in the diagnosis, assessment and management of COPD, as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ ERS research statement highlights the types of research that leading clinicians, researchers, and patient advocates believe will have the greatest impact on patient-centred outcomes. @ERSpublications ATS/ERS statement: which types of research will have the greatest future impact on patient-centred outcomes in COPD? http://ow.ly/I54Hb

Background: Alveolar macrophages (AMs) play key roles in the pathogenesis of chronic obstructive pulmonary disease (COPD). The aim of this study was to characterise the mechanisms of defective phagocytosis in AMs from COPD patients. We hypothesised that respiratory viruses could impair the ability of AMs to phagocytose lung bacteria. Materials and methods: AMs were isolated from bronchoalveolar lavage (BAL) and phenotyped using flow cytometry. AMs were pre-challenged with major or minor group rhinoviruses (RVs) and then phagocytosis of Moraxella catarrhalis or non-typeable Haemophilus influenzae (NTHi) examined. We repeated experiments using monocyte-derived macrophages (MDMs). Results: AMs consisted of separate populations. AMs from COPD patients had reduced cell surface marker expression, were immature and defective in phagocytosis and bacterial clearance. AMs pre-infected with major group RVs showed reduced phagocytosis, not seen in AMs pre-infected with a minor group RV. This inhibition was likely viral mediated because it was not observed in AMs treated with UV inactivated virus. Using MDMs we observed the same. We are currently investigating how viral infection or viral products affect the capacities of macrophages to engulf bacteria, generate phagolysosomes and eliminate them, and produce cytokines. Conclusion: Our results suggest AMs from COPD patients are phenotypically different to AMs from healthy patients and defective in phagocytosis. We show major group RVs impair AM and MDM phagocytic functions. These results could explain why COPD patients show exacerbations with bacterial pathogens found in the lung and why they show infections with major group RVs first.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and resource use worldwide. The goal of this Official American Thoracic Society (ATS)/European Respiratory Society (ERS) Research Statement is to describe evidence related to diagnosis, assessment, and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management. METHODS: Clinicians, researchers, and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarized, and then salient knowledge gaps were identified. RESULTS: Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulated via discussion and consensus. CONCLUSIONS: Great strides have been made in the diagnosis, assessment, and management of COPD as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ERS Research Statement highlights the types of research that leading clinicians, researchers, and patient advocates believe will have the greatest impact on patient-centered outcomes.