Bronchiectasis Hospitalizations Deadlier, Costlier Than Those for COPD, Asthma

Hospitalizations for bronchiectasis exacerbations are associated with worse outcomes than those for exacerbations of chronic obstructive pulmonary disease (COPD) or asthma, according to a study recently published in ERJ Open Research.¹

Evaluating Hospitalization Trends Across Airway Diseases

Although bronchiectasis is increasingly recognized as a distinct clinical entity, gaps remain in understanding how its hospitalization patterns and outcomes compare with those of more common airway diseases. Closing these gaps could help inform clinical practice and guide health care policy to improve treatment outcomes for patients with bronchiectasis, the researchers noted.

To address this, they evaluated hospitalizations for bronchiectasis, COPD, and asthma exacerbations from 2017 to 2021 using data from the National Inpatient Sample (NIS), a US all-payer database comprising a stratified sample of about 20% of inpatient discharges nationwide.²

The analysis included patient demographics, hospital characteristics, comorbidities, costs, length of stay, and mortality.¹ The researchers also examined the impact of the COVID-19 pandemic on hospitalization rates and mortality. Additionally, a secondary analysis assessed outcomes among patients with bronchiectasis who also had overlapping airway diseases.

The study population included adult patients hospitalized between 2017 and 2021 with a principal or secondary discharge diagnosis of bronchiectasis, COPD, or asthma exacerbations. To focus specifically on bronchiectasis outcomes, patients with bronchiectasis who also had COPD or asthma exacerbations were exclusively included in the bronchiectasis cohort.

Bronchiectasis Hospitalizations Linked to Increased Mortality, Costs

The bronchiectasis cohort consisted of 232,825 patients, with a median age of 72 (IQR, 57-81) years. By comparison, the COPD cohort comprised 8,403,302 patients (median age, 70; IQR, 61-78), and the asthma cohort included 1,278,839 patients (median age, 56; IQR, 42-69).

Each cohort was predominantly female, with women representing 71% of the asthma cohort, 59% of the bronchiectasis cohort, and 53.3% of the COPD cohort. Additionally, all 3 cohorts were mostly White, with 79.4% in the COPD cohort, 73.2% in the bronchiectasis cohort, and 51.9% in the asthma cohort.

The median (IQR) hospital length of stay was highest in the bronchiectasis cohort (5 [3-9] days) and lowest in the asthma cohort (3 [2-5] days). Hospital costs were also highest for bronchiectasis, with a median (IQR) of $50,393 ($28,432-$96,242) per hospitalization.

Additionally, crude mortality was highest among patients with bronchiectasis (5.8%), followed by COPD (5.0%; P < .0001) and asthma (1.5%; P < .0001). After adjusting for comorbidities, patients hospitalized for bronchiectasis exacerbations were 1.2 times more likely to die than those with COPD and 3.0 times more likely to die than those with asthma exacerbations (P < .0001 for both).

The rate of hospitalizations for COPD and asthma exacerbations decreased by 26% and 28%, respectively, during the COVID-19 pandemic compared with pre-pandemic levels. In contrast, hospitalizations for bronchiectasis fell by only 8%. While COPD and asthma hospitalizations continued to decline in 2021, bronchiectasis hospitalizations increased from 42,374 in 2020 to 45,866 in 2021, nearing pre-pandemic levels.

Across all 3 cohorts, mortality rates remained relatively stable during the pre-pandemic years but rose significantly in 2020 and again in 2021. The bronchiectasis cohort saw the greatest increase, with mortality rising from about 4.3% pre-pandemic to 7.3% in 2020 and 9.3% in 2021.

The secondary analysis found that hospitalizations for bronchiectasis alone (n = 174,600) were associated with higher mortality rates than bronchiectasis-COPD (n = 45,000) or bronchiectasis-asthma (n = 11,230) overlap. Specifically, patients with bronchiectasis-only exacerbations were more than 3 times more likely to die than those with bronchiectasis-asthma overlap.

Advancing Clinical Strategies for Bronchiectasis

The researchers concluded by acknowledging their limitations, including that the NIS captures hospital encounters rather than unique patients, which may over-represent individuals with recurrent hospitalizations. Despite this, they emphasized the clinical significance of their findings.

“The findings highlight the need for more targeted management strategies and increased awareness of bronchiectasis to improve patient outcomes and further reduce health care burden,” the authors wrote.

References

1. El Labban M, Al-Itelat A, Aksamit TR, Chalmers SJ, Kanj AN. Hospitalisations for bronchiectasis compared to COPD and asthma in the USA. ERJ Open Res. 2025;11(6):00048-2025. doi:10.1183/23120541.00048-2025
2. NIS overview. Agency for Healthcare Research and Quality. Accessed November 19, 2025. https://hcup-us.ahrq.gov/nisoverview.jsp