S53 Hiding in plain sight: using BTS guidance to identify and optimise management of ‘asthma-ectasis’ and ABPA through clinical phenotyping of a bronchiectasis cohort

Abstract

<h3>Introduction</h3> Combining BTS/SIGN/NICE Asthma guidance with the recent BTS guidance on pulmonary aspergillosis (2025) a clear diagnostic pathway for clinical phenotyping of ABPA and Asthma within Bronchiectasis cohorts is now possible. We utlised this guidance to clinically phenotype those with asthma or ABPA within a specialist bronchiectasis service to optimise management and identify those in need of escalation or de-escalation of therapy. <h3>Methods</h3> The database of a specialist bronchiectasis service was interrogated. Patients with radiological evidence of bronchiectasis and a co-diagnosis of asthma were identified. The 2024 joint BTS/NICE/SIGN asthma criteria was retrospectively applied. In those identified as having asthma, the new diagnostic criteria for ABPA were evaluated. From primary and secondary care electronic records, healthcare utilization burden, inhaled therapy and oral corticosteroids usage was compared between ABPA and non-ABPA cohorts. <h3>Results</h3> Of the 113 patients with bronchiectasis and historical asthma diagnosis, 86 patients met current diagnostic criteria for asthma. Of these, 24 also met the diagnostic criteria for ABPA. In the 27 bronchiectasis patients with no current evidence of asthma, 25 were prescribed inhaled corticosteroids with an annual cost of £10,144 and 2,736 kg of CO2. Respiratory clinic attendance was more frequent in the preceding 12 months for patients with ABPA (median 3.5) than with ‘asthma-ectasis’ (2, p = 0.0114) (figure 1). Of the Asthma-ABPA cohort,16 patients have been highlighted for consideration of escalation of asthma therapy, including biologics, based on corticosteroid use or exacerbation frequency. <h3>Conclusion</h3> Historical asthma diagnoses are common in bronchiectasis patients, but updated guidance suggests many may be suitable for de-labelling and de-escalation of therapy.¹ Inappropriate corticosteroid treatment carries significant morbidity risk, with financial and environmental cost. Concurrently others with ‘asthma-ectasis’ may require escalation of asthma therapy including biologics but this need may be masked by concurrent bronchiectasis. New guidance allows effective clinical phenotyping to formally identify specific cohorts with overlap between Asthma, Bronchiectasis and ABPA to improve access to expertise and treatment options to reduce healthcare burden and morbidity. <h3>Reference</h3> Pollock, Jennifer <i>et al. Thorax</i> 2025;<b>80</b>(6):358–368.