The existence of bronchiectasis predicts worse prognosis in patients with COPD

Abstract

Bronchiectasis is prevalent in patients with COPD. The objective of this study was to assess the clinical characteristics and prognostic value of bronchiectasis in patients with COPD in China. Data from patients diagnosed with COPD at the Shanghai Pulmonary Hospital between January 2009 and December 2013 were retrospectively collected and analyzed. SPSS statistical software was used to analyze the data. Data from 896 patients with COPD were analyzed. Bronchiectasis was present in 311 patients. The isolation of pseudomonas aeruginosa (PA) from sputum was the variable most significantly associated with the presence of bronchiectasis in patients with COPD (hazard ratio (HR), 2.93; 95% confidence interval (CI), 1.35–6.37; P = 0.007). During follow-up (median of 21 months; interquartile range: 10-39 months), there were 75 deaths, of which 39 were in the bronchiectasis group. The presence of bronchiectasis (HR, 1.77; 95% CI, 1.02–3.08; P = 0.043) was associated with an increase in all-cause mortality in patients with COPD. These results suggest that bronchiectasis in patients with COPD was associated with the isolation of PA from the sputum. Bronchiectasis was an independent risk factor for all-cause mortality in patients with COPD.

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

“…Therefore, besides medical history, typical manifestations of inactive tuberculosis on CT were also used as the diagnostic criterion of previous tuberculosis in our study. Our results showed that the prevalence of previous tuberculosis was 43% in patients with moderate–severe COPD, which was much higher than that previously reported, [2,4,11] but consistent with the findings by Allwood and coworkers. [35] Taken together, these findings suggest that previous tuberculosis of the lung may be an important cause of coexistent bronchiectasis in COPD, and previous tuberculosis should be incorporated into the assessment of COPD, particularly in tuberculosis prevalent countries.…”

“…Interestingly, there is also a high prevalence of pulmonary tuberculosis in COPD patients, [30,33,34] and tuberculosis is defined as a risk factor for COPD by GOLD. [1] A study by Mao et al [2] showed that the proportion of patients with previous lung tuberculosis defined by a medical history was 12.1% in a Chinese cohort of COPD (n = 896). However, another population survey (age ≥ 50 years, n = 8066) in China [11] demonstrated that the proportion of people with previous lung tuberculosis was 24.2% when the diagnosis was made based on the manifestation of “inactive tuberculosis” on chest radiograph.…”

“…A qualified sputum sample was defined as having fewer than 10 squamous epithelial cells and >25 leukocytes per low-powered field. [2,4] …”

“…The existence of bronchiectasis was shown to be associated with more severe symptoms, higher frequency of exacerbations and mortality, by several studies. [2–5] Therefore, bronchiectasis has been proposed as one of the comorbidities of COPD by global initiative for chronic obstructive lung disease (GOLD) 2014. [1] The etiology of noncystic fibrosis bronchiectasis is mostly associated with pulmonary infection (viral, bacterial, Mycobacterial, or fungal) and chronic inflammation of bronchi, although other factors such as malnutrition and extremes of age are also contributory to its occurrence.…”

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

“…Bronchiectasis and COPD often coexist with a varying prevalence amongst study populations (29%‐57%) 22, 23, 24, 25. Both diseases share several pathophysiological features including increased airway inflammation, propensity for exacerbations, distortion of the architecture of the lung parenchyma and bacterial colonisation of the airways.…”