Skip to main content

The Establishment of China Bronchiectasis Registry and Research Collaboration (BE-China): Protocol of a prospective multicenter observational study



Bronchiectasis is a highly heterogeneous chronic airway disease with marked geographic and ethnic variations. Most influential cohort studies to date have been performed in Europe and USA, which serve as the examples for developing a cohort study in China where there is a high burden of bronchiectasis. The Establishment of China Bronchiectasis Registry and Research Collaboration (BE-China) is designed to: (1) describe the clinical characteristics and natural history of bronchiectasis in China and identify the differences of bronchiectasis between the western countries and China; (2) identify the risk factors associated with disease progression in Chinese population; (3) elucidate the phenotype and endotype of bronchiectasis by integrating the genome, microbiome, proteome, and transcriptome with detailed clinical data; (4) facilitate large randomized controlled trials in China.


The BE-China is an ongoing prospective, longitudinal, multi-center, observational cohort study aiming to recruit a minimum of 10,000 patients, which was initiated in January 2020 in China. Comprehensive data, including medical history, aetiological testing, lung function, microbiological profiles, radiological scores, comorbidities, mental status, and quality of life (QoL), will be collected at baseline. Patients will be followed up annually for up to 10 years to record longitudinal data on outcomes, treatment patterns and QoL. Biospecimens, if possible, will be collected and stored at − 80 °C for further research. Up to October 2021, the BE-China has enrolled 3758 patients, and collected 666 blood samples and 196 sputum samples from 91 medical centers. The study protocol has been approved by the Shanghai Pulmonary Hospital ethics committee, and all collaborating centers have received approvals from their local ethics committee. All patients will be required to provide written informed consent to their participation.


Findings of the BE-China will be crucial to reveal the clinical characteristics and natural history of bronchiectasis and facilitate evidence-based clinical practice in China.

Trial registration Registration Number in NCT03643653


Non-cystic fibrosis bronchiectasis (hereafter referred to as bronchiectasis) has historically been a neglected respiratory diseases, and our current practice in the management of bronchiectasis is largely extrapolated from chronic obstructive pulmonary disease (COPD) and cystic fibrosis rather than supported by high-quality evidence [1]. However, recent epidemiological studies have clearly shown that the prevalence and incidence of bronchiectasis are quickly rising both in high and low-income countries possibly at least in part-owing to the aging populations and the extended use of high-resolution computed tomography (HRCT) [2,3,4]. Thus, bronchiectasis is posing an increasing burden on healthcare systems around the world with an effect on patient’s quality of life (QoL) and survival [2,3,4,5], suggesting an urgent need for better resourced research into this condition.

An upsurged interest in recent years has transformed the field of bronchiectasis. We now have clearer definitions and classifications of the disease [6], specific QoL tools [7, 8], multidimensional severity assessment tools [5, 9,10,11], and more robust evidence-based treatments such as airway clearance, macrolides, and inhaled antibiotics [12,13,14,15,16,17]. Everyone within the field would agree that large-scale registries with regular and long-term follow-up, such as European Multicenter Bronchiectasis Audit and Research Collaboration (EMBARC) and US bronchiectasis registry, have made a major contribution to these advances [5, 6, 12, 13, 16,17,18,19], and have clarified with greater power and accuracy the patients’ demographics, the microbiological profiles, the most common aetiologies and the burden of disease including symptoms, comorbidities, QoL and frequency of exacerbations [20,21,22,23,24,25,26]. However, most epidemiological data in the field of adult bronchiectasis [5, 6, 12, 13, 16,17,18,19,20,21,22,23,24,25,26] to date are limited to cohorts from Europe and the USA, with few data from Asian countries, including from China—the most populous country [20, 27, 28]. Recently, national registries have been established in Korea, Australia and India, which will add more evidence to the Asian phenotypes of bronchiectasis [20, 29,30,31]. Emerging data have shown that there may be substantial differences between Asian patients and western patients regarding the aetiology, microbiological profiles, disease severity and comorbidities [20, 29,30,31]. However, the characteristics of bronchiectasis may vary according to the country and socioeconomic status of the targeted population [32]. The Establishment of China Bronchiectasis Registry and Research Collaboration (BE-China) would allow us to better understand the characterization of Chinese bronchiectasis patients and test whether the phenotypes identified in western cohorts could be validated in China, which could provide valuable insights into geographical and ethnic differences of bronchiectasis.

The heterogeneity of bronchiectasis remains the greatest clinical challenge [1]. Currently, there are no licensed therapies for bronchiectasis and the successful clinical trials in bronchiectasis are still insufficient to support evidence-based interventions possibly due to the poor understanding of the pathophysiology of the disease [12,13,14]. Specimens are invaluable clinical research resources for genetic and molecular studies to reveal the endotype and pathogenesis. Therefore, the development of biologic resources embedded in registry as a backbone to build a repository of blood, sputum and other biological materials for use in translational research, will help us to better understand the pathophysiology of bronchiectasis, to better phenotype patients and individualize their management. EMBARC has made a substantial contribution to the translational research in bronchiectasis in the past few years [33,34,35], but we still have a long way to fully understand this disease or offer the evidence-based personalized management for patients with bronchiectasis. Additional state-of-art biobank, outside of western populations, is vital for further microbiome, proteome, genome and transcriptome research due to the potentially varying genetic background and molecular characteristics among patients from different geographic regions.

The BE-China is formally initiated in January 2020, which is the only large prospective, multicenter, longitudinal cohort study in adult bronchiectasis across China. The BE-China will recruit eligible individual bronchiectasis patients, and comprehensively collect their clinical data, as well as specimens with longitudinal follow-up for future research. Herein, we describe the rational and design of the BE-China registry.

Methods and analyses

Study design and objectives

The BE-China registry, initiated in January 2020, is a Yangtze River Delta region-based nationwide, multicenter, prospective, longitudinal, observational cohort study platform which aims to enroll a minimum of 10,000 consecutive adult patients with radiologically confirmed bronchiectasis in China. Enrolled patients are managed by trained and certified local physicians at each participating center according to clinical practice and guidelines without imposed interventions. The number of participating centers and their locations are shown in Fig. 1.

Fig. 1
figure 1

The number of 91 participating medical centers in the BE-China and their locations across China. Shanghai has enrolled twenty-five medical centers; Zhejiang enrolled fifteen medical centers; Jiangsu enrolled eleven medical centers; Guangdong enrolled five medical centers; Beijing enrolled four medical centers; Jiangxi enrolled four medical centers; Hunan enrolled two medical centers; Guangxi enrolled two medical centers; Hubei, Fujian, Guizhou, Henan, Liaoning, Ningxia, Sichuan, Xinjiang, Yunnan, Chongqing, Hebei, Shandong, Tianjin, Shaanxi, Inner Mongolia, Anhui, Gansu, Tibet, Qinghai, Heilongjiang, Jilin, Hainan, Shanxi enrolled one medical center each; Hong Kong, Macau and Taiwan did not enroll any medical center, respectively

Comprehensive data, including demographics, medical history, comorbidities, aetiological testing, lung function, echocardiography, microbiological profiles in sputum or bronchoalveolar lavage fluid (BALF), radiological scores, QoL and treatment, are collected at baseline (recruitment) during the steady-state. The patients will be followed up to 10 years on annual basis (within a 3-month variance) aligned to routine clinical attendance. In addition, the recruiting centers with access to appropriate facilities are encouraged to biobank the sputum, serum, plasma, blood cells, BALF and lung tissue, if possible, both at steady-state and exacerbation. The designs of the registry are presented in Fig. 2.

Fig. 2
figure 2

Study flowchart of the BE-China

The main objectives of the BE-China are to:

  1. 1.

    Characterize the demographics, aetiology, lung function, microbiological profiles, exacerbation, disease severity, QoL and treatment of the Chinese bronchiectasis patients;

  2. 2.

    Validate the phenotype of bronchiectasis identified in the Western cohorts and figure out the differences between China and the Western countries;

  3. 3.

    Elucidate the risk factors associated with deteriorating QoL, rapid decline of lung function, frequent exacerbation, and mortality;

  4. 4.

    Follow the natural history of disease in individual aetiologies;

  5. 5.

    Explore the new bronchiectasis phenotype and endotype of stable disease and exacerbation through integrating the clinical data, microbiome, proteomics, and genomics in China;

  6. 6.

    Facilitate large-scale randomized controlled trials in China.

To address the potential ethnic and geographic differences, we have established some main predefined hypotheses. To this end, we aim to compare clinical characteristics of the population of patients who suffer from bronchiectasis between China and other regions across the world, and to perform exploratory analyses about the risk factors which may contribute to clinically important outcome measures in bronchiectasis (such as exacerbation, QoL and mortality).

Participants, inclusion and exclusion criteria

The inclusion criteria of this registry are: (1) patients aged 18 years or older with a clinical history consistent with bronchiectasis (chronic cough, daily sputum production, and a history of exacerbations) and having performed chest HRCT in the past year indicating bronchiectasis which affects one or more lobes; (2) remaining clinically stable upon recruitment. Patients with exacerbations are allowed to be enrolled into the registry at least 4 weeks after antibiotic discontinuation.

The exclusion criteria are as follows: (1) traction bronchiectasis associated with interstitial lung disease or other pulmonary disorders; (2) cystic fibrosis associated bronchiectasis; (3) patients who are unable or unwilling to provide informed consent.

Specimens and biobank settings

Samples will be biobanked at each individual center if appropriate facilities are available. Blood, sputum, BALF and lung tissue samples of the enrolled patients who are able to provide consent, are collected via local well-trained investigators according to critical standard operating procedure. The blood will be centrifuged, and divided into three aliquots (plasma, serum, or blood cells, respectively). Unprocessed spontaneous sputum will be aliquoted. Per protocol, among patients with diffuse bronchiectasis, BALF samples will be conducted in the right middle lobe or left lingula lobe. In the case of localized bronchiectasis, the targeted segment is chosen based on chest HRCT scan. BALF samples are centrifuged for 20 min at 3184 g at 4 °C. The supernatant is then divided into aliquots. The aliquoted blood, sputum, lung tissue, BALF supernatant and cell pellets will be stored at − 80 °C for further genetic, proteomic and microbiome analyses. Participants can still be enrolled into the registry platform even if they are unable to provide samples.

Data collection

Three parts of data are collected in BE-China Registry: (1) baseline data; (2) annual follow-up data; (3) data at exacerbation. The detailed information is described as follows (Table 1):

Table 1 Data collection at baseline, exacerbation and follow-up in the BE-China
  1. 1.

    Demographic data age, sex, body-mass index (BMI), ethnic groups (such as Han, Hui, Tibetan, Mongol, Uyghur and so on), the highest educational level, occupational status, medical insurance and annual household income. The highest educational level is stratified into the following groups: illiteracy, elementary school graduate, junior high school graduate, senior high school graduate or equivalent, and college graduate or above. The occupational categories include manual workers, farmers, unemployed individuals, businessmen, clerks, professionals, managers, government employees or others where occupations should be clearly recorded. The annual household income is recorded in the total RenMinBi (RMB). The medical insurance of each patient is recorded in the following groups: no medical insurance, new rural cooperative medical insurance, commercial medical insurance, urban resident medical insurance, urban employee medical insurance.

  2. 2.

    Health-related QoL

    The registry will use both “QoL-Bronchiectasis” questionnaire (QoL-B) and Bronchiectasis Health Questionnaire (BHQ) to evaluate QoL [7, 8, 36]. Both questionnaires are the disease-specific QoL tools that have been specially developed and validated for use in bronchiectasis. The Hospital Anxiety and Depression Scale is employed to evaluate the status of anxiety and depression in patients with bronchiectasis [37]. Gastroesophageal reflux disease questionnaire (Gerd-Q) is used to diagnose the gastroesophageal reflux disease in patients with bronchiectasis as the potential aetiology or comorbidity [38]. An automatic calculator tool of these questionnaires is incorporated into the registry platform to aid in the calculation.

  3. 3.

    Leicester Cough Questionnaire (LCQ)

    We have included the LCQ in our registry because it has been validated for use in bronchiectasis [39, 40]. Cough has been rated as one of the most troublesome symptom in bronchiectasis by most patients in a survey of 711 European patients with bronchiectasis [41]. Inclusion of this questionnaire will also allow comparison to other datasets.

  4. 4.

    Aetiology of bronchiectasis

    The physicians caring for patients will determine the aetiology of bronchiectasis based on medical history, extensive aetiological testing, and questionnaires. Items of aetiological testing will follow the recommendation by national and international guidelines [12,13,14], with blood cell counts, serum immunoglobulins (lg) (total lgG, lgA and lgM), and testing for allergic bronchopulmonary aspergillosis (ABPA) (total serum lgE, specific lgE to Aspergillus etc.) as the mandatory testing. Other aetiologial tests, including autoimmune disease, alpha one antitrypsin deficiency, cystic fibrosis, primary ciliary dyskinesia, are carried out in patients with suggestive clinical features determined by local physicians.

  5. 5.


    We define the exacerbations based on the criteria recommended by EMBARC consensus [42], in which exacerbations are defined as a deterioration of three or more following symptoms for at least 48 h which require an immediate change of routine treatment: (1) cough; (2) sputum volume increase and/or consistent change; (3) sputum purulence; (4) dyspnea and/or exercise intolerance; (5) fatigue and/or malaise; (6) hemoptysis. Severe exacerbations are defined as exacerbations requiring an emergency room visit or hospitalization.

  6. 6.

    Sputum assessment

    Sputum colour is assessed using a validated photographic sputum colour chart that is graded as 1 (mucoid) to 4 (highly purulent) [43]. Sputum volume (mL/day) is estimated by patients’ report.

  7. 7.


    Pre-bronchodilator and post-bronchodilator spirometry are performed according to American Thoracic Society (ATS)/European Respiratory Society (ERS) guidelines [44]. The percentage of predicted values for forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) will be calculated by using a reference equation of Chinese people. In addition, total lung capacity, residual volume, inspiratory capacity, small airway function, or diffusion function assessed by spirometry are also collected when available.

  8. 8.

    Microbiological profiles

    The microbiological profiles from any sample (sputum, BALF or induced sputum) will be recorded either at steady-state or exacerbation. In addition, the data of fungi and non-tuberculous mycobacteria, including individual species, will be also collected.

  9. 9.

    Disease severity

    Both the Bronchiectasis Severity Index (BSI) and E-FACED are employed to assess the severity of bronchiectasis based on each variables [5, 9,10,11], with the total scores being calculated automatically at database platform.

  10. 10.


    Both pulmonary and extrapulmonary comorbidities are carefully collected [23]. Regarding pulmonary comorbidities, we record the presence or absence of physician-diagnosed asthma, COPD, rhinitis, chronic sinusitis and nasal polyp. Extrapulmonary comorbidities, including cardiovascular diseases, stroke, digestive diseases, endocrine diseases, hematological diseases, renal diseases, rheumatoid diseases, malignancy (including tumor sites) and immunodeficiency types will be recorded.

  11. 11.


    We use both the modified Reiff score and Bhalla score to assess the radiological severity of bronchiectasis [5, 45]. Physicians in each center determine the radiological score independently after careful training. Furthermore, images of chest CT scans at specific sites are required to be uploaded to the database platform for future use.

  12. 12.


    Echocardiography, which is recommended but not mandated, will be used to evaluate the left and right cardiac function in bronchiectasis. Patients with cardiac dysfunction or pulmonary hypertension are at greater risk of death in bronchiectasis [46, 47], which are commonly seen in China.

  13. 13.


    Regular treatment associated with bronchiectasis are recorded in detail, including airway clearance techniques, antibiotics (oral, inhaled, or nebulized), mucoactive drugs (oral or nebulized), long-acting muscarinic antagonist (LAMA), long-acting β2 agonist (LABA), inhaled corticosteroids (ICS), ICS/LABA, LABA/LAMA, ICS/LABA/LAMA. Data on the use of long-term home oxygen therapy, non-invasive ventilation, intravenous immunoglobulin, ABPA related treatment (oral corticosteroids, anti-fungi drugs), along with the vaccination status are also collected.


Participants enrolled in the registry will be prospectively followed up on an annual basis (± 3 months) which is aligned to the routine clinical attendance to collect longitudinal data, including the changes in medication use, QoL, the number of exacerbation and hospitalization, lung function and survival data (including both death and lung transplant). In addition, patients are encouraged to contact their physicians when they experience an exacerbation during follow-up. Clinical data (including symptoms, lung function, microbiology in sputum and the use of medication) and specimens (including blood and sputum samples) before antibiotic prescription at exacerbation, are collected if possible (Fig. 2).

Quality control, data management and monitoring

The registry collects data via an electronic data capture (EDC) solution which is designed based on the electronic case report form (eCRF). Patient information is de-identified and confidentially collected and then entered into the BE-China platform which was built on a secure website ( All electronic data are protected by account and passwords.

Several strategies are undertaken to manage the data and ensure quality control. First, the EDC system and eCRF are designed with the built-in logic checks during data entry. Second, each eligible center should designate one or two knowledgeable clinical research coordinators, who have been trained by centralized coordinators according to research protocols, to collect and record patient data in the EDC system to ensure the completeness and accuracy of each entered data. Third, data quality is monitored by a dedicated project and data management team according to predefined procedures. Once abnormal or missing values are detected, queries will be sent by the EDC system automatically to local investigators to check and revise the data. Moreover, research and data quality control report will be generated and circulated to all participating centers and local investigators periodically by Email or Wechart software. Each local investigators can access their own data without restrictions. However, complete data analysis requires submission of a research proposal to the BE-China Scientific Committee, and then access can be granted after approval of the research proposal.

Ethics and dissemination

Patients will receive regular follow-up at the outpatient clinic or via telephone by the local investigators. All patients will be required to sign written informed consent by the ethics committee according to the Declaration of Helsinki and local regulatory polices at each center. The BE-China has been registered in the clinical trials registry ( with an identifier of NCT03643653. The BE-China study group will follow the recommendations regarding authorship provided by the International Committee of Medical Journal Editors. The findings will be disseminated via publication in peer-reviewed journals, conference presentations, or academic website.


This is a nationwide prospective multicenter ongoing registry in adults with bronchiectasis, which is formally launched in January 2020 in mainland China. Until November 2021, 3758 patients have been recruited. The main objectives of the registry aim to describe the disease spectrum and natural history of bronchiectasis by long-term follow-up, as well as to reveal the phenotypes/endotypes and facilitate large randomized controlled trials among the Chinese bronchiectasis patients.

To date, seven ongoing large-scale registries have been established in Europe as well as in individual countries in the past decade (Table 2) [18,19,20,21, 48, 49], which have significantly improved our understanding of bronchiectasis. EMBARC, which was established in 2012 [18], represents the first and largest truly international bronchiectasis network around the world, and thus far it has enrolled more than 19,000 patients who are planned to be followed-up for 5 years. Since its establishment, EMBARC investigators have published more than 70 papers spanning from aetiology, endophenotypes to disease management of bronchiectasis [19, 22,23,24,25,26, 33,34,35, 50], and the first international guideline for the management of bronchiectasis [12]. The success of EMBRAC highlights the importance of establishing the large-scale bronchiectasis registry with long-term follow up to uncover the heterogeneity of the disease, which could not be achieved by single-center small sample studies. The registries in India and Korea have demonstrated substantial geographic and ethic difference of the disease between Asian and Western countries [20, 29,30,31]. However, the registries in Asia, do not collect biologic specimens and only enroll a limited number of participants. In addition, previous clinical trials in bronchiectasis, such as RESPIRE [51, 52], have demonstrated that patients from different geographic region behaved differently to what was expected with devastating consequences for the trial. This illustrates that the more data about geographic and ethnic differences of bronchiectasis should be clearly addressed.

Table 2 Summary of six ongoing large registry studies on adults with bronchiectasis around the world

The designated functions of the BE-China could compensate above unaddressed gaps. This registry comprehensively collects the clinical data of all enrolled patients from steady-state to exacerbation, as well as during annual follow-up, which makes the descriptions of the natural history of the disease feasible and practical. Disease characteristics and progression patterns will be compared among different subgroup patients stratified by demographics (e.g., age, gender, BMI) or clinical features (e.g., aetiology, disease severity, comorbidities). In addition, risk factors that contribute to poor outcomes (deteriorated QoL, progressive lung function decline, frequent exacerbation, and mortality) and the corresponding predicted tool will be developed and validated. Furthermore, we will compare the clinical characteristics, progression patterns and management of bronchiectasis between China and Western countries, or other Asian countries by international collaborations. Also, we will test whether the phenotype and endotype identified in western populations can be validated in Chinese patients. The substantial heterogeneity of bronchiectasis underscores the importance of a better mechanistic understanding of its pathology and progression. The biobanking of samples matched with the detailed clinical data, will allow us to conduct mechanistic research in the future. In short, we believe the BE-China will not only promote bronchiectasis research in China, but also facilitate multidisciplinary collaborative research around the world.

Certain limitations should be acknowledged. Since the patients will be mainly enrolled from secondary and tertiary hospitals, it appears that patients may not represent the full profiles of bronchiectasis across China. However, the referral system in China is not strict, and patients can go directly to public hospitals for all outpatients care. The representation of patients will be not a major concern. In addition, similar with any other registry study, withdrawal of patients and missing data may result in bias and there may be other unidentified or unmeasured confounding factors.


In conclusion, BE-China will establish a rich set of clinical and biological database on a large cohort of well-characterized individuals with bronchiectasis in China. The registry will provide unique and detailed insight into disease characteristics and progression patterns among Chinese patients and lay the foundation for international collaboration in the future.

Data availability

Not applicable.



Allergic bronchopulmonary aspergillosis


American Thoracic Society


Bronchoalveolar lavage fluid


The Establishment of China Bronchiectasis Registry and Research Collaboration


Bronchiectasis Health Questionnaire


Bronchiectasis Severity Index


Chronic obstructive pulmonary disease


Electronic case report form


Electronic data capture


European Multicenter Bronchiectasis Audit and Research Collaboration


European Respiratory Society

FEV1 :

Forced expiratory volume in one second


Forced vital capacity


Gastroesophageal reflux disease questionnaire


High-resolution computed tomography


Inhaled corticosteroids




Interquartile range


Long-acting muscarinic antagonist


Long-acting β2 agonist


Leicester Cough Questionnaire


Quality of life


Standard deviation


  1. Chalmers JD, Chang AB, Chotirmall SH, et al. Bronchiectasis. Nat Rev Dis Prim. 2018;4:45.

    Article  PubMed  Google Scholar 

  2. Quint JK, Millett ERC, Joshi M, et al. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: a population-based cohort study. Eur Respir J. 2016;47:186–93.

    Article  PubMed  Google Scholar 

  3. Ringshausen FC, Roux AD, Diel R, et al. Bronchiectasis in Germany: a population-based estimation of disease prevalence. Eur Respir J. 2015;46:1805–7.

    Article  PubMed  CAS  Google Scholar 

  4. Feng J, Sun L, Sun X, et al. Increasing prevalence and burden of bronchiectasis in urban Chinese adults, 2013–2017: a nationwide population-based cohort study. Respir Res. 2022;23:111.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chalmers JD, Goeminne P, Aliberti S, et al. The bronchiectasis severity index. An international derivation and validation study. Am J Respir Crit Care Med. 2014;189:576–85.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Aliberti S, Goeminne PC, O’Donnell AE, et al. Criteria and definitions for the radiological and clinical diagnosis of bronchiectasis in adults for use in clinical trials: international consensus recommendations. Lancet Respir Med. 2022;10:298–306.

    Article  PubMed  Google Scholar 

  7. Quittner AL, Marciel KK, Salathe MA, et al. A preliminary qualify of life questionnaire-bronchiectasis: a patient-reported outcome measure for bronchiectasis. Chest. 2014;146:437–48.

    Article  PubMed  Google Scholar 

  8. Spinou A, Siegert RJ, Guan WJ, et al. The development and validation of the bronchiectasis health questionnaire. Eur Respir J. 2017;49:1601532.

    Article  PubMed  Google Scholar 

  9. Martínez-García MÁ, de Gracia J, VendrellRelat M, et al. Multidimensional approach to non-cystic fibrosis bronchiectasis: the FACED score. Eur Respir J. 2014;43:1357–67.

    Article  PubMed  Google Scholar 

  10. Martinez-Garcia MA, Athanazio RA, Girón R, et al. Predicting high risk of exacerbations in bronchiectasis: the E-FACED score. Int J Chron Obstruct Pulmon Dis. 2017;12:275–84.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Wang H, Ji XB, Li CW, et al. Clinical characteristics and validation of bronchiectasis severity score systems for post-tuberculosis bronchiectasis. Clin Respir J. 2018;12:2346–53.

    Article  PubMed  CAS  Google Scholar 

  12. Polverino E, Goeminne PC, McDonnell MJ, et al. European respiratory society guidelines for the management of adult bronchiectasis. Eur Respir J. 2017;50:1700629.

    Article  PubMed  Google Scholar 

  13. Hill AT, Sullivan AL, Chalmers JD, et al. British thoracic society guideline for bronchiectasis in adults. Thorax. 2019;74(Suppl 1):1–69.

    Article  PubMed  Google Scholar 

  14. Bronchiectasis Expert Consensus Writing Group, Pulmonary Infection Assembly, Chinese Thoracic Society. Expert consensus on the diagnosis and treatment of adult bronchiectasis in China. Zhonghua Jie He He Hu Xi Za Zhi. 2021;44:311–21.

    Google Scholar 

  15. Muñoz G, de Gracia J, Buxó M, et al. Long-term benefits of airway clearance in bronchiectasis: a randomized placebo-controlled trial. Eur Respir J. 2018;51:1701926.

    Article  PubMed  Google Scholar 

  16. Chalmers JD, Boersma W, Lonergan M, et al. Long-term macrolide antibiotics for the treatment of bronchiectasis in adults: an individual participant data meta-analysis. Lancet Respir Med. 2019;7:845–54.

    Article  PubMed  CAS  Google Scholar 

  17. Laska IF, Crichton ML, Shoemark A, et al. The efficacy and safety of inhaled antibiotics for the treatment of bronchiectasis in adults: a systematic review and meta-analysis. Lancet Respir Med. 2019;7:855–69.

    Article  PubMed  CAS  Google Scholar 

  18. Chalmers JD, Aliberti S, Polverino E, et al. The EMBARC European bronchiectasis registry: protocol for an international observational study. ERJ Open Res. 2016;2:00081.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Aliberti S, Polverino E, Chalmers JD, et al. The European multicentre bronchiectasis audit and research collaboration (EMBARC) ERS clinical research collaboration. Eur Respir J. 2018;52:1802074.

    Article  PubMed  Google Scholar 

  20. Dhar R, Singh S, Talwar D, et al. Bronchiectasis in India: results from the European multicentre bronchiectasis audit and research collaboration (EMBARC) and respiratory research network India registry. Lancet Glob Health. 2019;7:e1269–79.

    Article  PubMed  Google Scholar 

  21. Aksamit TR, O’Donnell AE, Barker A, et al. Adult patients with bronchiectasis: a first look at the US bronchiectasis research registry. Chest. 2017;151:982–92.

    Article  PubMed  Google Scholar 

  22. Lonni S, Chalmers JD, Goeminne PC, et al. Etiology of non-cystic fibrosis bronchiectasis in adults and its correlation to disease severity. Ann Am Thorac Soc. 2015;12:1764–70.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Araújo D, Shteinberg M, Aliberti S, et al. The independent contribution of Pseudomonas aeruginosa infection to long-term clinical outcomes in bronchiectasis. Eur Respir J. 2018;51:1701953.

    Article  PubMed  Google Scholar 

  24. McDonnell MJ, Aliberti S, Goeminne PC, et al. Comorbidities and the risk of mortality in patients with bronchiectasis: an international multicentre cohort study. Lancet Respir Med. 2016;4:969–79.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Gao YH, Abo Leyah H, Finch S, et al. Relationship between symptoms, exacerbations, and treatment response in bronchiectasis. Am J Respir Crit Care Med. 2020;201:1499–507.

    Article  PubMed  Google Scholar 

  26. Chalmers JD, Aliberti S, Filonenko A, et al. Characterization of the “frequent exacerbator phenotype” in bronchiectasis. Am J Respir Crit Care Med. 2018;197:1410–20.

    Article  PubMed  Google Scholar 

  27. Wang N, Qu JM, Xu JF. Bronchiectasis management in China, what we can learn from European respiratory society guidelines. Chin Med J. 2018;131:1891–3.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Lin JL, Xu JF, Qu JM. Bronchiectasis in China. Ann Am Thorac Soc. 2016;13:609–16.

    Article  PubMed  Google Scholar 

  29. Lee H, Choi H, Sim YS, et al. KMBARC registry: protocol for a multicentre observational cohort study on non-cystic fibrosis bronchiectasis in Korea. BMJ Open. 2020;10: e034090.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Lee H, Choi H, Chalmers JD, et al. Characteristics of bronchiectasis in Korea: first data from the Korean multicenter bronchiectasis audit and research collaboration registry and comparison with other international registries. Respirology. 2021;26:619–21.

    Article  PubMed  Google Scholar 

  31. Visser SK, Bye PTP, Fox GJ, et al. Australian adults with bronchiectasis: the first report from the Australian bronchiectasis registry. Respir Med. 2019;155:97–103.

    Article  PubMed  Google Scholar 

  32. Chandrasekaran R, Mac Aogáin M, Chalmers JD, et al. Geographic variation in the aetiology, epidemiology and microbiology of bronchiectasis. BMC Pulm Med. 2018;18:83.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Finch S, Shoemark A, Dicker AJ, et al. Pregnancy zone protein is associated with airway infection, neutrophil extracellular trap formation, and disease severity in bronchiectasis. Am J Respir Crit Care Med. 2019;200:992–1001.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Keir HR, Shoemark A, Dicker AJ, et al. Neutrophil extracellular traps, disease severity, and antibiotic response in bronchiectasis: an international, observational, multicohort study. Lancet Respir Med. 2021;9:873–84.

    Article  PubMed  CAS  Google Scholar 

  35. Dicker AJ, Lonergan M, Keir HR, et al. The sputum microbiome and clinical outcomes in patients with bronchiectasis: a prospective observational study. Lancet Respir Med. 2021;9:885–96.

    Article  PubMed  CAS  Google Scholar 

  36. Guan WJ, Xu JF, Luo H, et al. A double-blind randomized placebo-controlled phase 3 trial of tobramycin inhalation solution in adults with bronchiectasis with Pseudomonas aeruginosa infection. Chest. 2022;S0012–3692(22):01247–8.

    Google Scholar 

  37. Gao YH, Guan WJ, Zhu YN, et al. Anxiety and depression in adult outpatients with bronchiectasis: associations with disease severity and health-related quality of life. Clin Respir J. 2018;12:1485–94.

    Article  PubMed  Google Scholar 

  38. Guan WJ, Gao YH, Xu G, et al. Aetiology of bronchiectasis in Guangzhou, southern China. Respirology. 2015;20:739–48.

    Article  PubMed  Google Scholar 

  39. Murray MP, Turnbull K, MacQuarrie S, et al. Validation of the Leicester cough questionnaire in non-cystic fibrosis bronchiectasis. Eur Respir J. 2009;34:125–31.

    Article  PubMed  CAS  Google Scholar 

  40. Gao YH, Guan WJ, Xu G, et al. Validation of the Mandarin Chinese version of the Leicester cough questionnaire in bronchiectasis. Int J Tuberc Lung Dis. 2014;18:1431–7.

    Article  PubMed  Google Scholar 

  41. Aliberti S, Masefield S, Polverino E, et al. Research priorities in bronchiectasis: a consensus statement from the EMBARC clinical research collaboration. Eur Respir J. 2016;48:632–47.

    Article  PubMed  Google Scholar 

  42. Hill AT, Haworth CS, Aliberti S, et al. Pulmonary exacerbation in adults with bronchiectasis: a consensus definition for clinical research. Eur Respir J. 2017;49:1700051.

    Article  PubMed  Google Scholar 

  43. Murray MP, Pentland JL, Turnbull K, et al. Sputum color: a useful clinical tool in non-cystic fibrosis bronchiectasis. Eur Respir J. 2009;34:361–4.

    Article  PubMed  CAS  Google Scholar 

  44. Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–38.

    Article  PubMed  CAS  Google Scholar 

  45. Bedi P, Chalmers JD, Goeminne PC, et al. The BRICS (bronchiectasis radiologically indexed CT score): a multicenter study score for use in idiopathic and postinfective bronchiectasis. Chest. 2018;153:1177–86.

    Article  PubMed  Google Scholar 

  46. Alzeer AH, Al-Mobeirek AF, Al-Otair HA, et al. Right and left ventricular function and pulmonary artery pressure in patients with bronchiectasis. Chest. 2008;133:468–73.

    Article  PubMed  Google Scholar 

  47. Wang L, Jiang S, Shi J, et al. Clinical characteristics of pulmonary hypertension in bronchiectasis. Front Med. 2016;10:336–44.

    Article  PubMed  Google Scholar 

  48. De Soyza A, Mawson P, Hill AT, et al. BronchUK: protocol for an observational cohort study and biobank in bronchiectasis. ERJ Open Res. 2021;7:00775–2020.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Martinez-García MA, Villa C, Dobarganes Y, et al. RIBRON: the Spanish online bronchiectasis registry. Characterization of the first 1912 patients. Arch Bronconeumol. 2021;57:28–35.

    Article  PubMed  Google Scholar 

  50. Chalmers JD, Haworth CS, Metersky ML, et al. Phase 2 trial of the DPP-1 inhibitor brensocatib in bronchiectasis. N Engl J Med. 2020;383:2127–37.

    Article  PubMed  CAS  Google Scholar 

  51. De Soyza A, Aksamit T, Bandel TJ, et al. RESPIRE 1: a phase III placebo-controlled randomised trial of ciprofloxacin dry powder for inhalation in non-cystic fibrosis bronchiectasis. Eur Respir J. 2018;51:1702052.

    Article  PubMed  Google Scholar 

  52. Aksamit T, De Soyza A, Bandel TJ, et al. RESPIRE 2: a phase III placebo-controlled randomised trial of ciprofloxacin dry powder for inhalation in non-cystic fibrosis bronchiectasis. Eur Respir J. 2018;51:1702053.

    Article  PubMed  Google Scholar 

Download references


The authors would like to thank the participation of all eligible patients with bronchiectasis. Thanks for the great work of all the sub-centers investigators in China bronchiectasis registry and research collaboration (BE-China).


This work was supported by the National Natural Science Foundation of China (81925001 to JFX; 82270047 to YHG); the Innovation Program of Shanghai Municipal Education Commission (202101070007-E00097); Program of Shanghai Municipal Science and Technology Commission (21DZ2201800); Innovative research team of high-level local universities in Shanghai and Innovative team of Shanghai Pulmonary Hospital.

Author information

Authors and Affiliations



YHG and JFX drafted the first version of this manuscript; HWL, BM, WJG, YLS, RCC, JMQ, JFX conceived and designed the overall study; RCC, JMQ and JFX are responsible for study oversight, management and coordination. All authors reviewed the manuscript for intellectual content. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Rong-Chang Chen, Jie-Ming Qu or Jin-Fu Xu.

Ethics declarations

Ethics approval and consent to participate

This study received necessary approval from institutional Review Boards of all participating institutions.

Consent for publication

Not required.

Competing interests

All authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gao, YH., Lu, HW., Mao, B. et al. The Establishment of China Bronchiectasis Registry and Research Collaboration (BE-China): Protocol of a prospective multicenter observational study. Respir Res 23, 328 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: