Clinical characteristics of patients with chronic obstructive pulmonary disease with comorbid bronchiectasis: a systemic review and meta-analysis

Abstract

BackgroundIn the 2014 Global initiative for chronic Obstructive Lung Disease guidelines, bronchiectasis was for the first time defined as a comorbidity of chronic obstructive pulmonary disease (COPD), and this change has been retained in the 2015 update, which emphasizes the influence of bronchiectasis in the natural history of COPD. The present meta-analysis was aimed at summarizing the impact of bronchiectasis on patients with COPD.MethodsDatabases including Embase, PubMed, and the Cochrane Central Register of Controlled Trials were searched comprehensively to identify all relevant human clinical studies published until August 2014. Bronchiectasis was confirmed either by computed tomography or high-resolution computed tomography. One or more clinicopathological or demographical characteristics, including age, sex, smoking history, daily sputum production, exacerbations, inflammatory biomarkers, lung function, and colonization by potentially pathogenic microorganisms (PPMs), were compared between COPD patients with and without bronchiectasis.ResultsSix observational studies with 881 patients were included in the meta-analysis. The mean prevalence of bronchiectasis in patients with COPD was 54.3%, ranging from 25.6% to 69%. Coexistence of bronchiectasis and COPD occurred more often in male patients with longer smoking history. Patients with COPD and comorbid bronchiectasis had greater daily sputum production, more frequent exacerbation, poorer lung function, higher level of inflammatory biomarkers, more chronic colonization by PPMs, and higher rate of Pseudomonas aeruginosa isolation.ConclusionIn spite of the heterogeneity between included studies and detectable publication bias, this meta-analysis demonstrated the impact of bronchiectasis in patients with COPD in all directions, indicating that coexistence of bronchiectasis should be considered a pathological phenotype of COPD, which may have a predictive value.

Factors associated with bronchiectasis in patients with moderate–severe chronic obstructive pulmonary disease

“…Several studies [4,5,36,37] demonstrated that gender seemed to have an effect on bronchiectasis occurrence in patients with COPD, and recently, a meta-analysis [38] also showed that COPD patients with bronchiectasis were mostly males. In our study, male gender was shown to be a risk factor for bronchiectasis in patients with moderate–severe COPD.…”

“…In our study, male gender was shown to be a risk factor for bronchiectasis in patients with moderate–severe COPD. Ni and coworkers [38] suggested that higher smoking rate in males could explain this phenomenon. However, no significant effect of smoking status was found on the presence and extent of bronchiectasis in our study.…”

Suspecting non-cystic fibrosis bronchiectasis: What the busy primary care clinician needs to know

“…A follow‐up study from the same group showed that patients with bronchiectasis and COPD had an increased risk of all‐cause mortality 26. A meta‐analysis of 881 patients, including the above studies in addition to four others, revealed that the coexistence of COPD and bronchiectasis was associated with higher exacerbation rates, degree of inflammatory markers, and rates of Pseudomonas aeruginosa isolation 27. For these reasons, bronchiectasis is now considered a common comorbidity in patients with COPD 21.…”

Diagnostic challenges of bronchiectasis

“…Ni et al including six observational studies with 881 COPD patients, the mean prevalence of bronchiectasis was 54,3% [23]. A study in the UK showed that 29% of patients with COPD followed in primary care had morphological alterations of airway potentially classifiable as bronchiectasis [24].…”