The Impact of Bronchiectasis in Clinical Presentation of Asthma

Oğuzülgen, I. Kıvılcım; Kervan, Firdevs; Öziş, Türkan Nadir; Türktaş, Haluk

doi:10.1097/smj.0b013e31802fa16f

Cited by 60 publications

(48 citation statements)

References 12 publications

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“…The widely accepted diagnostic criteria for bronchial dilation are internal diameter greater than adjacent pulmonary artery or lack of tapering or visibility of peripheral airways. According to these criteria, the prevalence of bronchial dilatation in asthmatic patients has been reported to be 3% to 66.7% (40,42). Bronchial dilation can also occur in healthy subjects, but the prevalence has been reported to be much lower than that in asthmatic subjects (28,30,41,43).…”

Section: Discussionmentioning

confidence: 99%

A morphologic study of the airway structure abnormalities in patients with asthma by high-resolution computed tomography

Wang¹,

Luo²,

Du³

et al. 2016

J. Thorac. Dis.

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Background: Airway structure changes, termed as airway remodeling, are common in asthma patients due to chronic inflammation, which can be assessed by high-resolution computed tomography (HRCT).Considering the controversial conclusions in the correlation of morphologic abnormalities with clinical feature and outcome, we aimed to further specify and evaluate the structural abnormalities of Chinese asthmatics by HRCT.Methods: From August 2012 to February 2015, outpatients with asthma were recruited consecutively in the Asthma Center of West China Hospital, Sichuan University. Standard HRCT and pulmonary function test (PFT) were performed to collect information of bronchial wall thickening, bronchial dilatation, mucus impaction, emphysema, mosaic perfusion, atelectasis, and spirometric parameters. We reported the incidence of each structural abnormality in HRCT and compared it among different asthmatic severities.Results: A total of 123 asthmatics were enrolled, among which 84 (68.3%) were female and 39 (31.7%) were male. At least one structural abnormality was detected by HRCT in 85.4% asthmatics, and the incidence of bronchial wall thickening, bronchial dilatation, mucus impaction, emphysema, mosaic perfusion, and atelectasis was 57.7%, 51.2%, 22%, 24.4%, 5.7% and 1.6%, respectively. The incidences of bronchial wall thickening, bronchial dilation and emphysema were significantly increased by asthma severity (P<0.05), while incidences of mucus impaction (26/27, 96.30%), mosaic perfusion (6/7, 85.71%) and atelectasis (2/2, 100%) were mainly found in severe asthma. We found a longer asthma history (28.13±18.55 years, P<0.001, P=0.035, respectively).Conclusions: The incidences of structural abnormalities detected by HRCT are fairly high in Chinese asthma populations, especially the bronchial wall thickening and bronchial dilation, which are significantly increased in severe asthma, and are potential risk factors of pulmonary function decline in asthmatics.

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Section: Discussionmentioning

confidence: 99%

A morphologic study of the airway structure abnormalities in patients with asthma by high-resolution computed tomography

Wang¹,

Luo²,

Du³

et al. 2016

J. Thorac. Dis.

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“…The prevalence of bronchiectasis in patients with severe asthma is relatively high; with 25–40% of patients having radiological signs of bronchiectasis [91,92], compared to 3% in a population of generally milder asthma [93]. …”

Section: Systematic Assessment Of Severe Asthmamentioning

confidence: 99%

“…Asthma patients with co-existing bronchiectasis appear to be at higher risk of asthma exacerbations and hospitalizations [93,94]. Bronchiectasis per se may cause obstructive airflow limitation [92], and is thus a also a differential diagnosis of asthma [95].…”

Section: Systematic Assessment Of Severe Asthmamentioning

confidence: 99%

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

Porsbjerg

Ulrik

Skjold

et al. 2018

European Clinical Respiratory Journal

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Although a minority of asthma patients suffer from severe asthma, they represent a major clinical challenge in terms of poor symptom control despite high-dose treatment, risk of exacerbations, and side effects. Novel biological treatments may benefit patients with severe asthma, but are expensive, and are only effective in appropriately targeted patients. In some patients, symptoms are driven by other factors than asthma, and all patients with suspected severe asthma (‘difficult asthma’) should undergo systematic assessment, in order to differentiate between true severe asthma, and ‘difficult-to-treat’ patients, in whom poor control is related to factors such as poor adherence or co-morbidities. The Nordic Consensus Statement on severe asthma was developed by the Nordic Severe Asthma Network, consisting of members from Norway, Sweden, Finland, Denmark, Iceland and Estonia, including representatives from the respective national respiratory scientific societies with the aim to provide an overview and recommendations regarding the diagnosis, systematic assessment and management of severe asthma. Furthermore, the Consensus Statement proposes recommendations for the organization of severe asthma management in primary, secondary, and tertiary care.

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“…Another had functional antibody deficiency. All four patients carried a diagnosis of asthma, which has been rarely associated with bronchiectasis (14), although in two, pulmonary function showed no obstruction and the asthma diagnosis was adult onset, suggesting the possibility that the symptoms attributed to asthma were actually related to CSLD. Our patients' symptoms of chronic purulent sputum production, infection with unusual organisms and the presence of underlying immune defects are not suggestive of either neutrophilic or eosinophilic asthma.…”

Section: A B a B Discussionmentioning

confidence: 99%

Chronic suppurative lung disease in adults

Metersky

Mangardich

2016

J. Thorac. Dis.

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Chronic suppurative lung disease (CSLD), characterized by a bronchiectasis-like syndrome in the absence of bronchial dilatation, is well described in the pediatric literature. In some patients, it may be a precursor of bronchiectasis. In adults, this syndrome has not been well described. We present four adult patients without obvious causative exposures who presented with prolonged cough and purulent sputum.Sputum cultures revealed a variety of Gram negative bacteria, fungi and mycobacteria. High resolution CT scanning did not reveal bronchiectasis. Evaluation revealed underlying causes including immunodeficiency in two, and Mycobacterium avium infection. One patient subsequently developed bronchiectasis. All patients improved with therapy. CSLD occurs in adults and has characteristics that distinguish it from typical chronic bronchitis. These include the lack of causative environmental exposures and infection with unusual pathogens. Evaluation and treatment of these patients similar to bronchiectasis patients may lead to clinical improvement. J Thorac Dis 2016;8(9):E974-E978 jtd.amegroups.com level were normal. He was now producing a half cup of yellow-green sputum daily, thus it was felt that he was a good candidate for azithromycin at 250 mg 3 times a week, as would be indicated for bronchiectasis patients. Three months later, he reported an "80% improvement" in his cough, which was then productive of only scant clear sputum and he has continued to do well with azithromycin and an airway clearance regimen. Case 2A 66-year-old male with a history of life-long asthma which was reasonably well controlled without systemic steroids, was referred for a several year history of daily cough of approximately a tablespoon of yellow sputum. His respiratory symptoms periodically worsened, and he experienced six exacerbations requiring antibiotics in the year prior to his referral. He had a 12-pack-year smoking history, discontinued more than 20 years previously. Physical examination was significant for a wet cough, rhinitis and diminished breath sounds at the lung bases. Spirometry testing showed borderline low FEV 1 /FVC ratio of 71% and sagging of the expiratory loop, but an FEV 1 of 111% of predicted and no bronchodilator response. Blood work showed an elevated IgE level at 590 kU/L. Other immunoglobulins, alpha-1 antitrypsin level and a cystic fibrosis (CF) mutation screen were normal. Sputum cultures showed Aspergillus fumigatus, Bordetella bronchiseptica, Pseudomonas aer uginosa and Mycobacterium avium complex (MAC). Aspergillus IgG and IgE were elevated, although the IgE elevation was borderline (0.47 kU/L, upper limit of normal 0.32 kU/L), suggesting the possibility of allergic bronchopulmonary aspergillosis. An HRCT from approximately 3 years prior to his referral, but after the onset of symptoms, demonstrated some areas of bronchial wall thickening but no bronchiectasis (Figure 2A). A HRCT after his referral demonstrated bronchiectasis, bronchial wall thickening and mucus impaction in his left lower lo...

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The Impact of Bronchiectasis in Clinical Presentation of Asthma

Abstract: These data show that bronchiectasis can contribute to severe and difficult to control asthma with pulmonary complications like chronic respiratory failure.

Cited by 60 publications

References 12 publications

A morphologic study of the airway structure abnormalities in patients with asthma by high-resolution computed tomography

A morphologic study of the airway structure abnormalities in patients with asthma by high-resolution computed tomography

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

Chronic suppurative lung disease in adults

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