Severe COVID-19 Linked to Higher Exacerbation, Mortality Risks in Patients With Bronchiectasis

Individuals with bronchiectasis face an increased risk of exacerbation and mortality following recovery from COVID-19, particularly after severe cases, according to a study published in ERJ Open Research.¹

Past research determined that COVID-19 may trigger exacerbations in this population, even after recovery.² However, these studies were limited by small sample sizes, a focus on mild to moderate cases, and a lack of data on long-term mortality.¹ As a result, the impact of COVID-19 severity on severe exacerbation and mortality risk in patients with bronchiectasis remained unclear.

To address these gaps, the researchers evaluated long-term risks of exacerbation and mortality among patients with bronchiectasis following recovery from both severe and nonsevere COVID-19 cases. They used data from the Republic of Korea’s National Health Insurance Service, a mandatory universal health care provider covering about 97% of the population.³ Eligible individuals were diagnosed with bronchiectasis between January 1, 2015, and October 7, 2020.¹

The study’s primary outcomes were the long-term risk of severe bronchiectasis exacerbation and all-cause mortality. To evaluate exacerbation risk, patients were followed until the first occurrence of severe exacerbation, death, or December 31, 2021, whichever came first. For the mortality analysis, follow-up continued until death or September 30, 2022.

Among 48,342 eligible individuals with bronchiectasis, 2711 had recovered from COVID-19. After 1:1 propensity score matching, a COVID-19 cohort (n = 2711) and a matched cohort (n = 2711) were included in the final analysis.

The COVID-19 cohort was further stratified by disease severity: 536 had severe COVID-19, and 2175 had nonsevere COVID-19. Patients in the severe COVID-19 cohort were more likely to be older (median age, 73 vs 67; standardized mean difference [SMD], 0.39) and male (52.4% vs 40.0%; SMD, 0.17) than those in the nonsevere COVID-19 cohort.

Over a median follow-up of 70 days (IQR, 31-216), including a median 14-day COVID-19 recovery period, the incidence of severe bronchiectasis exacerbation was 305.6 per 10,000 person-years in the matched cohort and 402.2 per 10,000 person-years in the COVID-19 cohort. Stratified by COVID-19 severity, the incidence was 273.3 per 10,000 person-years in the non-severe cohort and 855.9 per 10,000 person-years in the severe cohort.

As a result, the severe COVID-19 cohort had a significantly higher risk of severe exacerbation compared with the matched cohort (adjusted HR [aHR], 2.38; 95% CI, 1.25-4.51). However, this increased risk was not observed in the nonsevere cohort.

Similarly, during a median follow-up of 71 days (IQR, 32-129), including the 14-day recovery period, the all-cause mortality rate was 221.2 per 10,000 person-years in the matched cohort and 342.9 per 10,000 person-years in the COVID-19 cohort (P = .001). The researchers highlighted that the COVID-19 cohort exhibited a significantly higher mortality risk than the matched cohort (aHR, 1.46; 95% CI, 1.06-2.01).

When broken down by COVID-19 severity, the mortality rate was 149.6 per 10,000 person-years in the non-severe cohort and 1132.1 per 10,000 person-years in the severe COVID-19 cohort (P < .001). Therefore, the severe COVID-19 cohort had a significantly higher mortality risk than the matched cohort (aHR, 2.99; 95% CI, 2.08-4.28). In contrast, the nonsevere cohort did not demonstrate a significantly higher mortality risk.

Lastly, the researchers acknowledged the limitations of their study, including the potential lack of generalizability due to its single-country setting. Still, they expressed confidence in the findings and their clinical implications.

“Our findings suggest that guidelines should emphasize vigilant monitoring…and include specific recommendations for managing COVID-19 in individuals with bronchiectasis,” the authors wrote. “Early and appropriate management may help prevent severe exacerbations. Furthermore, interventions such as pulmonary rehabilitation should be explored to prevent subsequent exacerbations.”

References

1. Kim SH, Kim JS, Kim MJ, et al. Exacerbation and mortality risk in individuals with bronchiectasis post-COVID-19 recovery. ERJ Open Res. 2025;11(3):00866-2024. doi:10.1183/23120541.00866-2024
2. Kwok WC, Ho JCM, Tam TCC, Ip MSM, Lam DCL. Increased exacerbations of bronchiectasis following recovery from mild COVID-19 in patients with non-cystic fibrosis bronchiectasis. Respirology. 2024;29(3):209-216. doi:10.1111/resp.14664
3. Shin DW, Cho J, Park JH, Cho B. National general health screening program in Korea: history, current status, and future direction: a scoping review. Precis Future Med. 2022;6(1):9-31. doi:10.23838/pfm.2021.00135