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

Abstract

BackgroundFew studies have evaluated the coexistence of bronchiectasis (BE) and chronic obstructive pulmonary disease (COPD) in series of patients diagnosed primarily with BE. The aim of this study was to analyse the characteristics of patients with BE associated with COPD included in the Spanish Bronchiectasis Historical Registry and compare them to the remaining patients with non-cystic fibrosis BE.MethodsWe conducted a multicentre observational study of historical cohorts, analysing the characteristics of 1,790 patients who had been included in the registry between 2002 and 2011. Of these, 158 (8.8%) were registered as BE related to COPD and were compared to the remaining patients with BE of other aetiologies.ResultsPatients with COPD were mostly male, older, had a poorer respiratory function and more frequent exacerbations. There were no differences in the proportion of patients with chronic bronchial colonisation or in the isolated microorganisms. A significantly larger proportion of patients with COPD received treatment with bronchodilators, inhaled steroids and intravenous antibiotics, but there was no difference in the use of long term oral or inhaled antibiotherapy. During a follow-up period of 3.36 years, the overall proportion of deaths was 13.8%. When compared to the remaining aetiologies, patients with BE associated with COPD presented the highest mortality rate. The multivariate analysis showed that the diagnosis of COPD in a patient with BE as a primary diagnosis increased the risk of death by 1.77.ConclusionPatients with BE related to COPD have the same microbiological characteristics as patients with BE due to other aetiologies. They receive treatment with long term oral and inhaled antibiotics aimed at controlling chronic bronchial colonisation, even though the current COPD treatment guidelines do not envisage this type of therapy. These patients’ mortality is notably higher than that of remaining patients with non-cystic fibrosis BE.

Economic burden of bronchiectasis in Germany

“…Whilst in Cox´s regression the presence of COPD had no significant influence on mortality when comparing the bronchiectasis group and the whole matched control group in which also a considerable proportion of patients (35.9%) had COPD, mortality in the bronchiectasis group was nearly four times higher (HR 3.73; 95%CI: 2.52-5.53) than in the COPD-free part of the matched patient group. This is in line with recently published evidence [23] that mortality may be higher among those who also had COPD than in patients with bronchiectasis alone. Because mortality in the bronchiectasis group was highest at 8.23%…”

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

“…The mean hospitalization of 10.8 days in our series was also higher than that of COPD patients, which tended to be around 7 days [29,30]. With these data in mind, along with the increased prevalence of BE [4,5], the higher incidence of hospitalizations for BE [6,7,13], and the growing evidence of the latter's association with COPD [31][32][33], it is possible that the overall healthcare expenses due to BE are considerably higher than previously thought.…”

Association between Inhaled Corticosteroid Use and Pulmonary Nontuberculous Mycobacterial Infection

“…Finally, our inclusion of a broad range of clinical diagnoses of chronic obstructive diseases as designated by ICD-9 codes should be noted. Given the increasingly broad use of ICS in patients with chronic airway ORIGINAL RESEARCH diseases, and given the variability in assignment of disease diagnosis (and thus ICD code) by clinicians, plus the intrinsic biological and pathological overlaps that exist between specific chronic airway diseases, we chose to more broadly include chronic airway disease diagnoses, including COPD and asthma, in addition to bronchiectasis (21,(40)(41)(42)(43)(44).…”