Results Summary

What was the research about?

Bronchiectasis is a health problem that damages the airways that carry air to the lungs. Patients with bronchiectasis are likely to get lung infections.

Two kinds of medicines can prevent lung infections. The first is steroids that patients take from an inhaler. The second is an antibiotic that patients take by mouth, called macrolide monotherapy. Patients with bronchiectasis may need to take these medicines long term, or for more than 28 days.

In this study, the research team looked at Medicare claims for patients with bronchiectasis who had a long-term prescription for antibiotics or steroids. The team compared patients’ risk of lung infections such as pneumonia and nontuberculous mycobacterium, or NTM. They also looked at other health problems from long-term use of these medicines.

What were the results?

Compared with patients who were prescribed antibiotics, patients who were prescribed steroids had a higher risk of

  • A hospital stay for pneumonia or for any reason
  • Outpatient treatment for lung infections
  • Irregular heartbeat

However, they had a lower risk of hearing loss compared with patients who were prescribed antibiotics.

Patients who were prescribed steroids and those who were prescribed antibiotics had a similar risk of

  • Getting an NTM infection
  • Having a heart attack
  • Breaking a hip
  • Getting an infection due to a weakened immune system
  • Staying in the hospital because they coughed up blood
  • Dying

Who was in the study?

The study included Medicare claims for 90,089 adults treated for bronchiectasis; 83,589 were prescribed a steroid and 6,500 were prescribed an antibiotic. Of patients, 83 percent were white, 6 percent were black, 4 percent were Asian/Pacific Islander, and less than 1 percent were American Indian or Alaska native. Also, 6 percent were Hispanic. For 1 percent, race and ethnicity were unknown or other. The average age was 74, and 68 percent were women.

What did the research team do?

Using patient data from Medicare claims, the research team compared two groups. In the first, patients had a prescription for 28 days or more of steroids. In the second, patients had a prescription for 28 days or more of antibiotics. The team looked at the risk of lung infections or other health problems up to seven years after patients started the medicines. The team took into account other things, such as gender or other health problems, that might affect risk.

A group of patients with bronchiectasis provided input to the research team.

What were the limits of the study?

Most patients were over age 65; results may differ for younger patients. Medicare claims didn’t include information about patient’ symptoms or how sick they were. As a result, the research team couldn’t tell how well the medicines improved symptoms. Few patients had NTM infections, making it hard to detect differences between the two groups.

Future research could include younger patients and those with and without other lung problems.

How can people use the results?

Doctors and patients with bronchiectasis can use the results when considering treatments.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers wondered why the researchers revised the propensity scores (PS), calculated to account for differences in patient characteristics between intervention groups, to balance the treatment groups at 180 days after the start of treatment, rather than use the original PS at treatment start. The researchers explained that nontuberculous mycobacterium (NTM) infection can take a considerable amount of time to diagnose, so they felt that any incidences of NTM infection in the first six months were likely to be existing rather than new cases of disease. The researchers went on to explain that they recalculated PS because many things may have changed during those first six months that would affect the group balance established by the first PS calculations.
  • The reviewers suggested that the report needed a conclusion section that more clearly interpreted options for patients and physicians, rather than provided a summary of findings. The researchers updated their conclusion section to characterize the strength of evidence from the study as well as the overall results. They stood by the conclusion that macrolide therapy was likely to be a better choice than chronic inhaled corticosteroids (ICS) for older bronchiectasis patients to avoid hospitalization for respiratory infections. However, they also acknowledged that the study results could not determine whether this was due to a benefit of macrolides or a risk of chronic ICS because they could not compare risk related to either of these drug classes to the risk related to not starting any new drug class.
  • The reviewers commented that the report touts the involvement of patient advocacy organizations in the project but does not discuss the potential conflict of interest of an NTM advocacy organization receiving funding from pharmaceutical companies that may benefit from diagnosis and treatment of NTM. The researchers said they are very conscious of conflicts of interest and the need for transparency in research and noted that their project focused on two generic and widely available treatments. The researchers acknowledged that a partnership has recently been developed between drug developers and patient advocates for NTM disease, but said they saw this as a positive development, given lack of interest from federal funders or industry in the past.

Conflict of Interest Disclosures

Project Information

Kevin Winthrop, MD, MPH
Oregon Health & Science University
Comparative Effectiveness and Safety of Inhaled Corticosteroids and Antimicrobial Compounds for Non-CF Bronchiectasis

Key Dates

September 2015
March 2020

Study Registration Information


Has Results
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Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
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Last updated: April 11, 2024