Heterogeneity of non-cystic-fibrosis bronchiectasis in multiethnic Singapore: A prospective cohort study at a tertiary pulmonology centre

Abstract

Introduction: Non-cystic fibrosis bronchiectasis (NCFB) is a highly heterogenous disease. We describe the clinical characteristics of NCFB patients and evaluate the performance of Bronchiectasis Severity Index (BSI) in predicting mortality. Methods: Patients attending the bronchiectasis clinic between August 2015 and April 2020 with radiologically proven bronchiectasis on computed tomography were recruited. Clinical characteristics, spirometry, radiology, microbiology and clinical course over a median period of 2.4 years is presented. Results: A total of 168 patients were enrolled in this prospective cohort study. They were predominantly women (67.8%), Chinese (87.5%) and never-smokers (76.9%). Median age of diagnosis was 64 years (interquartile range 56–71) and the most common aetiology was “idiopathic” bronchiectasis (44.6%). Thirty-nine percent had normal spirometries. Compared to female patients, there were more smokers among the male patients (53.8% versus 8.5%, P<0.001) and a significantly larger proportion with post-tuberculous bronchiectasis (37.0% vs 15.8%, P=0.002). Fifty-five percent of our cohort had a history of haemoptysis. Lower body mass index, presence of chronic obstructive pulmonary disease, ever-smoker status, modified Reiff score, radiological severity and history of exacerbations were risk factors for mortality. Survival was significantly shorter in patients with severe bronchiectasis (BSI>9) compared to those with mild or moderate disease (BSI<9). The hazard ratio for severe disease (BSI>9) compared to mild disease (BSI 0–4) was 14.8 (confidence interval 1.929–114.235, P=0.01). Conclusion: The NCFB cohort in Singapore has unique characteristics with sex differences. Over half the patients had a history of haemoptysis. The BSI score is a useful predictor of mortality in our population. Keywords: Bronchiectasis, exacerbations, gender, haemoptysis, mortality, Reiff score, sex

Evaluating the Prevalence and Incidence of Bronchiectasis and Nontuberculous Mycobacteria in South Korea Using the Nationwide Population Data

“…A previous cohort study conducted in Taiwan also indicated the prevalence of bronchiectasis to be dominant in women [13]. Additionally, a Singaporean cohort study identified the preponderance of women [14]. However, contradicting results have also been identified in some studies, suggesting further investigation.…”

“…Despite study results indicating Asians to be at higher risk, there is a lack of comprehensive prevalence datasets and extensive research in the Asia-Pacific region [10]. A previous study conducted in Korea reported that 9.1% of patients undergoing medical examinations to have bronchiectasis [14]. Similar to reports from the U.S. and European countries, bronchiectasis in Korea has also indicated its relations to age, gender, a history of tuberculosis, and accompanying respiratory diseases [10,15].…”