Phenotyping Adults with Non-Cystic Fibrosis Bronchiectasis: A 10-Year Cohort Study in a French Regional University Hospital Center

Abstract

Background: Data concerning phenotypes in bronchiectasis are scarce. Objective: The aim of this study was to describe the clinical, functional and microbiological phenotypes of patients with bronchiectasis. Methods: A monocentric retrospective study in a university hospital in France was conducted over 10 years (2002-2012). Non-cystic fibrosis patients with tomographic confirmation of bronchiectasis were included. The clinical, functional and microbiological data of patients were analyzed relying on the underlying etiology. Results: Of the311 included patients, an etiology was found for 245 of them. At the time of diagnosis, the median age was 61 years and the mean FEV₁ was 63% of predicted. The main causes of bronchiectasis were post-infectious (50%, mostly related to tuberculosis), chronic obstructive pulmonary disease (COPD; 13%) and idiopathic (11%). Other causes were immune deficiency (6%), asthma (4%), autoimmunity (3%), tumor (2%) and other causes (4%). The comparison of phenotypic traits shows significant differences between COPD, congenital and idiopathic groups in term of sex (p = 0.0175), tobacco status (p < 0.0001), FEV₁ (p = 0.0412) and age at diagnosis (p < 0.001), Pseudomonas aeruginosa (PA) colonization (p = 0.0276) and lobectomy (0.0093). Functional follow-up was available in 30% of patients with a median duration of 2.7 years. Presence of PA was associated with a lower median FEV₁ at diagnosis (43% p < 0.003) but not with a faster rate of decline in FEV₁. Conclusion: Distinctive clinical, functional and microbiological features were found for idiopathic, congenital and COPD-related bronchiectasis. A prospective follow-up of these subgroups is necessary to validate their relevance in the management of bacterial colonization and specific complications of these bronchiectases.

Cost of Hospitalizations due to Exacerbation in Patients with Non-Cystic Fibrosis Bronchiectasis

“…In our study, the assignment of BE etiology depended on the criteria of the participant researcher, based on complementary tests and clinical history. Given the high age of the patients, both at the start of symptoms of BE (53.5 years), and at the time of diagnosis (61.6 years), it is understandable that in many cases, no exhaustive investigations were carried out to rule out etiologies that usually appear at younger ages [18]. Another striking fact is the high proportion of CBI by PA compared to other published series.…”

Clinical impact of chronic obstructive pulmonary disease on non-cystic fibrosis bronchiectasis. A study on 1,790 patients from the Spanish Bronchiectasis Historical Registry

“…More recent studies have included a larger number of cases [20–23] but some do not include individual clinical data [23]. In these series, COPD is considered to be an aetiology of BE in a higher percentage than in ours (11–36%) [21–25]. This difference might be attributed to the fact that the SBHR’s data were collected at a time when it was not common to consider COPD as a possible cause of BE.…”

Geographic variation in the aetiology, epidemiology and microbiology of bronchiectasis

“…The co-morbidities seen most commonly in Europe include COPD, asthma and IBD; all representing independent mortality risk factors in those with non-CF bronchiectasis [27]. COPD-associated bronchiectasis is a leading cause in Europe [3,[28][29][30] with allergic reactions to fungi belonging to the genus Aspergillus (Allergic bronchopulmonary aspergillosis -ABPA) particularly notable in United Kingdom (UK) based cohorts [28,31,32].…”