Exacerbations in COPD Patients with Bronchiectasis

Abstract

There is evidence that coexisting bronchiectasis (BE) in patients with chronic obstructive pulmonary disease (COPD) aggravates the course of the disease. In this study, we aimed to evaluate the frequency and severity of bacterial exacerbations in COPD patients with BE. The frequency and duration of bacterial exacerbations treated in a 12-month period, as well as the duration of the exacerbation-free interval, were evaluated in 54 patients with COPD (Group D) who were diagnosed and assessed according to official recommendations. In 27 patients, BE was diagnosed by high-resolution computed tomography (HRCT), whereas an equal number of COPD patients who were confirmed negative for BE by HRCT, served as controls. We found a significantly higher mean number of exacerbations in a 12-month period in COPD patients with BE (2.9 ± 0.5), as compared to their mean number in controls (2.5 ± 0.3) (p = 0.0008). The mean duration of exacerbation, i.e., the mean number of days elapsed before complete resolution of the symptoms or their return to the baseline severity, was significantly longer in COPD patients with BE as compared to their mean duration in controls (6.9 ± 1.8 vs. 5.7 ± 1.4; p = 0.0085). In addition, the mean exacerbation-free interval expressed in days, in patients with COPD with BE, was significantly shorter than in COPD patients in whom BE were excluded (56.4 ± 17.1 vs. 67.2 ± 14.3; p = 0.0149). Overall, our findings indicate that coexisting BE in COPD patients may lead to more frequent exacerbations with a longer duration.

Risk factors of chronic obstructive pulmonary disease exacerbations

“…Minov et al identified a shorter duration of exacerbation‐free interval (expressed in days) in patients with COPD and associated bronchiectasis than patients with COPD without BE (ranging from 37‐82 days vs 49‐88 days, P = 0.0149) …”

“…The eosinophil count is a marker for eosinophilic airway inflammation and a predictive biomarker for the efficacy of ICS treatment in patients with COPD exacerbations . COPD patients with eosinophilia (≥2%) have an increased risk of AECOPD . The first study to investigate the prevalence of blood eosinophilia (defined as ≥300 cells/L) among inpatients with AECOPD evidenced a higher frequency of exacerbations during the 1‐year follow‐up period compared to patients without eosinophilia .…”

“…Several studies showed that the association of bronchiectasis (BE) and COPD determined more frequent and severe exacerbations, with a longer duration, impaired quality of life and reduced survival . Association of these two diseases is more frequent in patients with severe airflow limitation …”

“…[68][69][70] COPD patients with eosinophilia (≥2%) have an increased risk of AECOPD. 5,[70][71][72][73] The first study to investigate the prevalence of blood eosinophilia (defined as ≥300 cells/L) among inpatients with AECOPD evidenced a higher frequency of exacerbations during the 1-year follow-up period compared to patients without eosinophilia. 68 Higher blood eosinophil cell count (≥200 cells/µL and/or ≥2%) at admission for an AECOPD is associated with increased COPD readmission rates even in patients with infrequent COPD hospitalisations.…”

“…Several studies showed that the association of bronchiectasis (BE) and COPD determined more frequent and severe exacerbations, with a longer duration, impaired quality of life and reduced survival. 19,71,106 Association of these two diseases is more frequent in patients with severe airflow limitation. 19,71 A study regarding the relationship between the presence of bronchiectasis and acute exacerbation in Thai COPD patients showed that frequent AECOPD exacerbations of ≥2 year or at least 1 hospitalisation in the previous year were associated with bronchiectasis (OR 4.99; 95% CI: 1.31-18.94; P = 0.018).…”