Bronchiectasis in severe asthma

Coman, Isabel; Pola-Bibian, B; Paredes, Pilar; Vilà-Nadal, Gemma; Domínguez‐Ortega, Javier; Romero, David; Villasante, C.; Quirce, Santiago

doi:10.1016/j.anai.2018.02.016

Cited by 56 publications

(22 citation statements)

References 41 publications

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“…We further confirmed that the coexistence of severe asthma and bronchiectasis is typical of elderly patients with late-onset non-atopic severe uncontrolled eosinophilic asthma 20. Accordingly to Olveira et al,21 the prevalence of bronchiectasis rises considerably in subjects with more severe asthma, as evident from the poorer lung function and lower control of the disease of the four subjects enrolled in our study.…”

Section: Discussionsupporting

confidence: 91%

“…Accordingly to Olveira et al,21 the prevalence of bronchiectasis rises considerably in subjects with more severe asthma, as evident from the poorer lung function and lower control of the disease of the four subjects enrolled in our study. As in this study, Coman et al20 further proved the higher incidence of exacerbations in patients with this phenotype, reporting more hospitalizations in severe asthmatics with bronchiectasis. This suggests that the coexistence of both pathologies worsens outcomes.…”

Section: Discussionsupporting

confidence: 74%

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<p>Severe uncontrolled asthma with bronchiectasis: a pilot study of an emerging phenotype that responds to mepolizumab</p>

Carpagnano¹,

Scioscia²,

Lacedonia³

et al. 2019

JAA

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Background Asthma and bronchiectasis are different conditions that frequently coexist. The prevalence of bronchiectasis rises considerably in subjects with severe asthma (25%–51%). Objective We evaluated the clinical and biological efficacy of mepolizumab on our pilot population of severe uncontrolled asthmatics with bronchiectasis not related to other pathologies. Patients and methods Four patients with severe uncontrolled asthma and diagnosed as bronchiectasis were recruited and started biological treatment with mepolizumab. Standard investigations were performed in all four patients at baseline (T0), after 3 months (T1) and after 1 year (T2) of treatment. Results After 1 year (T2) of therapy with mepolizumab, patients showed a significant increment of asthma control test value (12±1.1 vs 24.5±0.3, P <0.01), a reduction of the number of exacerbations/year (5±0.7 vs 0.75±0.75, P <0.01), an increase of pre-bronchodilator FEV 1 (1,680±500 vs 1,860±550 mL, P <0.01) and a reduction of eosinophils in blood (0.75±0.14 vs 0.12±0.02 cells/µL, P <0.01), in the sputum (9.6%±2.1% vs 5.6%±2.7%, P <0.05) and in nasal cytology (++ vs +). Conclusion The efficacy of mepolizumab in terms of reduction of inflammation and increase of control that we observed in our patients might suggest that targeting the IL-5 in severe eosinophilic asthma with bronchiectasis may be a good therapeutic strategy.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 74%

<p>Severe uncontrolled asthma with bronchiectasis: a pilot study of an emerging phenotype that responds to mepolizumab</p>

Carpagnano¹,

Scioscia²,

Lacedonia³

et al. 2019

JAA

View full text Add to dashboard Cite

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“…Although the prevalence of bronchiectasis is generally low in all patients with asthma, the prevalence increases by up to 25–51% in those with severe asthma. 13 , 28 , 29 Several studies reported a significant association between asthma exacerbation risk and bronchiectasis. 13 , 30 However, increased mortality in severe asthma due to bronchiectasis has not previously been published and is the novel finding of this study.…”

Section: Discussionmentioning

confidence: 99%

“… 13 , 28 , 29 Several studies reported a significant association between asthma exacerbation risk and bronchiectasis. 13 , 30 However, increased mortality in severe asthma due to bronchiectasis has not previously been published and is the novel finding of this study. We highlighted that bronchiectasis further increased mortality in patients with CS-dependent asthma whose mortality is higher than general asthma patients.…”

Section: Discussionmentioning

confidence: 99%

“…Comorbid bronchiectasis is one of the important factors that make the treatment of severe asthma difficult; bronchiectasis leads to poor symptom control with frequent exacerbation in patients with asthma. 12 – 14 In reverse, the existence of asthma is associated with an independent increase in the risk of bronchiectasis exacerbation. 15 – 17 Considering the compounding effect of bronchiectasis on the prognosis of asthma, it might be postulated that a comorbidity of bronchiectasis may increase the consumption of healthcare resources and mortality in patients with CS-dependent asthma.…”

Section: Introductionmentioning

confidence: 99%

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Bronchiectasis and increased mortality in patients with corticosteroid-dependent severe asthma: a nationwide population study

Choi

Lee

Ryu

et al. 2020

Ther Adv Respir Dis

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Background: Long-term corticosteroid (CS) use is associated with increased mortality in patients with asthma, and comorbid bronchiectasis is also associated with frequent asthma exacerbation and increased healthcare use. However, there is limited information on whether bronchiectasis further increases mortality in patients with CS-dependent asthma. This study examined the impact of bronchiectasis on mortality in patients with CS-dependent asthma. Methods: A retrospective cohort of patients with CS-dependent asthma ⩾18 years old was established using records from the Korean National Health Insurance Service database from 2005 to 2015. Patients with CS-dependent asthma with and without bronchiectasis were matched by age, sex, type of insurance, and Charlson comorbidity index. We evaluated the hazard ratio (HR) for all-cause mortality in patients with bronchiectasis compared with those without bronchiectasis. Results: The study cohort included 754 patients with CS-dependent asthma with bronchiectasis and 3016 patients with CS-dependent asthma without bronchiectasis. Patients with CS-dependent asthma with bronchiectasis had a higher all-cause mortality than those without bronchiectasis (8429/100,000 versus 6962/100,000 person-years, p < 0.001). The adjusted HR for mortality in patients with CS-dependent asthma with bronchiectasis relative to those without bronchiectasis was 1.33 (95% confidence interval, 1.18–1.50), and the association was primarily significant for respiratory diseases (subdistribution HR = 1.65, 95% confidence interval, 1.42–1.92). Conclusions: Bronchiectasis further increases all-cause mortality in patients with CS-dependent asthma, a trend that was especially associated with respiratory diseases including chronic obstructive pulmonary disease. Strategies to improve treatment outcomes in patients with CS-dependent asthma with bronchiectasis are urgently needed to improve long-term survival. The reviews of this paper are available via the supplemental material section.

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Prevalence and characterization of chronic rhinosinusitis in patients with non‒cystic fibrosis bronchiectasis at a tertiary care center in the United States

Somani

Kwah

Chen

et al. 2019

Int Forum Allergy Rhinol

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Background: Chronic rhinosinusitis (CRS) is associated with bronchiectasis; however, this relationship has not been well studied in the United States (US) population. In this work we aimed to determine the prevalence of CRS among patients with bronchiectasis affiliated with a US tertiary medical center and identify which comorbid diseases are associated with the presence of CRS in patients with bronchiectasis. Methods:This was a retrospective cohort study in which data were obtained from a large database warehouse at a tertiary care center. Patients with bronchiectasis were identified from 2007 to 2017 using diagnosis codes from the the ninth and tenth revisions of the International Classification of Diseases (ICD-9/10) and confirmed by radiographic evidence of bronchiectasis on chest computed tomography (CT) scans. Patients were divided into cohorts based on presence or absence of concomitant CRS. Characteristics analyzed included demographics, comorbidities, peripheral eosinophil counts, and pulmonary function testing.Results: CRS was present in 45% (408 of 900) of patients with bronchiectasis. Females represented a majority of bronchiectasis patients, both with and without CRS (69% and 64%, respectively, p = 0.09). A er controlling for demographic factors, asthma (p < 0.01), allergic rhinitis (p < 0.01), gastroesophageal reflux disease (p < 0.01), and antibody deficiency (p < 0.01) were associated with the presence of CRS in patients with bronchiectasis.Conclusion: CRS had a high prevalence and was associated with numerous comorbid conditions in patients with bronchiectasis. These findings have clinical implications for the treatment of patients with bronchiectasis and future research. C 2019 ARS-AAOA, LLC.

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Bronchiectasis in severe asthma

Cited by 56 publications

References 41 publications

<p>Severe uncontrolled asthma with bronchiectasis: a pilot study of an emerging phenotype that responds to mepolizumab</p>

<p>Severe uncontrolled asthma with bronchiectasis: a pilot study of an emerging phenotype that responds to mepolizumab</p>

Bronchiectasis and increased mortality in patients with corticosteroid-dependent severe asthma: a nationwide population study

Prevalence and characterization of chronic rhinosinusitis in patients with non‒cystic fibrosis bronchiectasis at a tertiary care center in the United States

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