Bronchiectasis in Italy: an analysis of the EMBARC registry

Background Bronchiectasis is a complex disease with geographical variability in its presentation and management. Despite the growing contribution of international registries, real-world data on 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 patients with bronchiectasis and to compare them with those of patients from other Southern European countries. Methods This was a secondary analysis of adults from 18 Italian centres included in the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) registry, with comparisons made to patients in Spain, Greece, Portugal, Turkey, Israel and Malta (Southern European countries). Demographics, comorbidities, exacerbation history, spirometry, microbiology and treatment patterns were evaluated. Results Among 1657 Italian patients, the majority were female (70.5%) with a median age of 65 years, with high rates of idiopathic bronchiectasis (55.4%) and preserved lung function. Compared with other Southern European countries (n=2638), Italian patients had lower disease severity (median Bronchiectasis Severity Index: 6 versus 7; p<0.001), less frequent isolation of Pseudomonas aeruginosa, and lower prevalence of daily sputum production and purulence, despite identical quality of life (median Quality of Life Questionnaire-Bronchiectasis Respiratory Symptom Score: 70.4 in both groups). Treatment patterns differed, with lower use of inhaled antibiotics (1.1% versus 13.1%) and macrolides (6.0% versus 14.3%), but more widespread use of airway clearance (48.4% versus 35.9%) among patients from Italy versus other Southern European countries. 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.