Rationale: Bronchiectasis guidelines regard treatment to prevent exacerbation and treatment of daily symptoms as separate objectives.Objectives: We hypothesized that patients with greater symptoms would be at higher risk of exacerbations and therefore that a treatment aimed at reducing daily symptoms would also reduce exacerbations in highly symptomatic patients.Methods: Our study comprised an observational cohort of 333 patients from the East of Scotland (2012-2016). Either symptoms were modeled as a continuous variable or patients were classified as having high, moderate, or low symptom burden (>70, 40-70, and <40 using the St. George's Respiratory Questionnaire symptom score). The hypothesis that exacerbation reductions would only be evident in highly symptomatic patients was tested in a post hoc analysis of a randomized trial of inhaled dry powder mannitol (N = 461 patients).Measurements and Main Results: In the observational cohort, daily symptoms were a significant predictor of future exacerbations (rate ratio [RR], 1.10; 95% confidence interval [CI], 1.03-1.17; P = 0.005). Patients with higher symptom scores had higher exacerbation rates (RR, 1.74; 95% CI, 1.12-2.72; P = 0.01) over 12-month follow-up than those with lower symptoms. Inhaled mannitol treatment improved the time to first exacerbation (hazard ratio, 0.56; 95% CI, 0.40-0.77; P < 0.001), and the proportion of patients remaining exacerbation free for 12 months of treatment was higher in the mannitol group (32.7% vs. 14.6%; RR, 2.84; 95% CI, 1.40-5.76; P = 0.003), but only in highly symptomatic patients. In contrast, no benefit was evident in patients with lower symptom burden.Conclusions: Highly symptomatic patients have increased risk of exacerbations, and exacerbation benefit with inhaled mannitol was only evident in patients with high symptom burden.

中文翻译：

---

支气管扩张的症状，病情加重与治疗反应之间的关系。

理由：支气管扩张指南将预防加重的治疗和每日症状的治疗作为单独目标。方法：我们的研究包括来自苏格兰东部（2012-2016年）的333名患者的观察队列。将症状建模为连续变量，或者将患者分类为具有高，中或低症状负担（使用圣乔治呼吸问卷症状评分> 70、40-70和<40）。在一项对吸入性干粉甘露醇的随机试验（N = 461例患者）进行事后分析中，证实了只有在症状高度严重的患者中才可加剧发作的假说。测量和主要结果：在观察队列中，日常症状是未来恶化的重要预测指标（比率[RR]为1.10； 95％置信区间[CI]为1.03-1.17； P = 0.005）。症状评分较高的患者在12个月的随访中加重率（RR，1.74； 95％CI，1.12-2.72； P = 0.01）比症状较轻的患者更高。吸入甘露醇治疗可改善首次发作的时间（危险比，0.56； 95％CI，0.40-0.77； P <0.001），并且在接受甘露醇治疗的12个月内，无急性发作的患者比例更高（32.7％） vs. 14.6％； RR：2.84； 95％CI：1.40-5.76；P = 0.003），但仅限于有症状的患者。相比之下，症状负荷较低的患者则无明显益处。结论：高症状患者的病情加重风险增加，而吸入甘露醇的病情恶化仅在症状负荷高的患者中明显。