High prevalence of bronchiectasis in emphysema-predominant COPD patients

Abstract

BackgroundCOPD has been identified as an etiology or related disease of bronchiectasis, and bronchiectasis has been classified as a comorbidity of COPD. In this study, we investigated the prevalence of bronchiectasis in different phenotypes of COPD subjects and the correlation between bronchiectasis and different phenotypes, especially emphysema.MethodsCOPD patients were recruited from April 2012 to December 2015. The presence of bronchiectasis and related information were statistically analyzed. COPD subjects were separated into subgroups in two ways: COPD with and without bronchiectasis groups and emphysema-predominant (emphysema index, EI≥9.9%) and non-emphysema-predominant (EI<9.9%) groups.ResultsIn total, 1,739 COPD patients were incorporated into the study, among which 140 cases (8.1%) were accompanied with radiological bronchiectasis. COPD patients with concomitant bronchiectasis presented worse pulmonary function (FEV1% predicted, P<0.001), higher EI (15.0% vs 13.4%, P<0.001), and higher proportion of pulmonary hypertension and cor pulmonale (6.4% vs 2.4%, P=0.005 and 23.6% vs 16.1%, P=0.022) than patients without bronchiectasis. Of all the COPD patients, 787 with EI data were divided into emphysema-predominant (n=369) and non-emphysema-predominant groups (n=418). The proportion of bronchiectasis was 16.5% and 10.3% (P=0.01), respectively. Severity of bronchiectasis increased as the degree of airflow limitation (r=−0.371, P<0.001) and emphysema increased (r=0.226, P=0.021). After adjusting confounding factors, FEV1% predicted (OR, 1.636; 95% CI, 1.219–2.197; P=0.001) and EI (OR, 1.993; 95% CI, 1.199–3.313; P=0.008) were significantly related with the presence of bronchiectasis in COPD patients.ConclusionThe proportion of bronchiectasis is higher in emphysema-predominant COPD subjects. Emphysema measured by EI and FEV1% predicted are independent predictors for bronchiectasis in COPD subjects, while the underlying mechanism deserves further investigation.

Impact of Radiographic Bronchiectasis in COPD

“…Of all of these, 14 duplicates were removed. After reviewing the titles and abstracts, 76 full-text articles were identified and reviewed, and, finally, 18 studies 11,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] were included in this systematic review and meta-analysis. The flow diagram of article selection according to the PRISMA guideline 13 is illustrated in Figure 1.…”

“…A total of 415,257 subjects with COPD from 18 observational studies 11,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] were eligible for this meta-analysis, and bronchiectasis was present in 25,929 subjects (6.24%). The sample size ranged from 54 to 386,646, and 6 studies [17][18]20,22,25,33 had a small population (N < 100).…”

“…The sample size ranged from 54 to 386,646, and 6 studies [17][18]20,22,25,33 had a small population (N < 100). Ten studies 11,[17][18][19][20]25,[27][28][32][33] were prospective (cohort studies) and 8 [21][22][23][24]26,[29][30][31] were retrospective (case-control studies) in design. The minimum study duration lasted for 1 year and the maximum lasted for 10 years.…”

“…Overall, the pooled data from the 18 studies 11,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] found that subjects with COPD and with bronchiectasis were older than those without bronchiectasis (WMD 0.57 y, 95% CI 0.45-0.70; P < .001, I 2 ¼ 46%). Pooled estimates from the 16 11,[17][18][19][21][22][23][24][25][26][27][28][29][30][31] studies found that there were no statistical differences with respect to sex (OR 0.95, 95% CI 0.84-1.09; P ¼ .48, I 2 ¼ 66%), as show in Table 2. Ten studies 11,19,[22][23][24][25][26][27][28][29]32 were included in the assessment of BMI, and these showed that the presence of bronchiectasis in the subjects with COPD was associated with a lower BMI (WMD -0.42 kg/m 2 , 95% CI -0.73 to À0.11; P ¼ .007, I 2 ¼ 43%) compared with subjects with COPD and without bronchiectasis.…”

Impact of bronchiectasis on long-term survival in patients with acute exacerbation of chronic obstructive pulmonary disease

“…COPD often coexists with other diseases (comorbidities) which may have significant impacts on prognosis of COPD patients. With increasing use of high-resolution computed tomography (HRCT) in assessment of COPD, a high prevalence of previously undiagnosed bronchiectasis was found in COPD patients, ranging from 8.1-69% [7][8][9][10][11][12][13][14][15][16][17][18][19]. Some previous studies suggested the presence of bronchiectasis predicted worse outcome of COPD patients [9-11, 13, 15, 20].Therefore, bronchiectasis was proposed as one of COPD comorbidities by 2014 global initiative for chronic obstructive lung disease (GOLD).…”