Impact of Radiographic Bronchiectasis in COPD

Abstract

BACKGROUND: COPD and bronchiectasis frequently coexist, which creates an emerging phenotype with a worse prognosis. However, the impact of bronchiectasis on the natural history of COPD has not been fully evaluated and is still controversial. This meta-analysis was performed to clarify the associations of the presence of bronchiectasis with the prognosis and quality of life of patients with COPD. METHODS: A systematic review and meta-analysis was performed following a search of medical databases, and included articles published up to April 2019. The following outcome measures were analyzed: age, sex, smoking history, body mass index, exacerbation rate, lung function, inflammatory biomarkers, albumin, colonization by potentially pathogenic microorganisms, Pseudomonas aeruginosa isolates, Haemophilus influenzae isolates, hospital admissions, and mortality. RESULTS: A total of 415,257 subjects with COPD from 18 observational studies were eligible; bronchiectasis was present in 25,929 subjects (6.24%). The coexistence of COPD and bronchiectasis occurred more often in older subjects with lower body mass index. The presence of bronchiectasis in the subjects with COPD increased the risk of daily sputum production (odds ratio [OR] 1.80, 95% CI 1.24-2.61), exacerbation (weighted mean difference [WMD] 0.72 times, 95% CI 0.59-0.85), frequent hospital admissions (WMD 0.35 times, 95% CI 0.21-0.49), and follow-up (>3 years) mortality (OR 2.26, 95% CI 0.95-5.36). The subjects with COPD and bronchiectasis showed poorer pulmonary function (FEV 1 /FVC: WMD-3.37%, 95% CI-5.63 to-1.11), lower albumin (Standardized mean difference [SMD]-0.17, 95% CI-0.26 to-0.08), elevated C-reactive protein (SMD 0.40, 95% CI 0.06-0.74), a greater proportion of chronic colonization by potentially pathogenic microorganisms (OR 6.65, 95% CI 4.44-9.95), and a higher isolation rate of P. aeruginosa (OR 5.13, 95% CI 4.89-5.38) or H. influenzae (OR 1.90, 95% CI 1.29-2.79) than the subjects with COPD without bronchiectasis. CONCLUSIONS: This meta-analysis confirmed the significant associations of the presence of bronchiectasis with the natural history, disease course, and outcomes in COPD. The COPDbronchiectasis phenotype had adverse effects on subjects' health condition and prognosis.

ROSE: radiology, obstruction, symptoms and exposure – a Delphi consensus definition of the association of COPD and bronchiectasis by the EMBARC Airways Working Group

“…Furthermore, numerous studies have shown that this association has a more severe clinical presentation and worse prognosis than each individual disease [16,17,[33][34][35][36][37][38]. However, there is no consensus on how this association should be defined.…”

“…The epidemiology of the association between COPD and BE is even less clear. In fact, the reported prevalence of BE in COPD patients varies considerably across series, from 4% to 75% [4,[15][16][17]. Different factors can be invoked to understand such variability in prevalence rates: series differ in inclusion criteria, severity of disease, definition of bronchiectasis and method used for radiological diagnosis.…”

“…Regardless of the primary diagnosis, the coexistence of COPD and bronchiectasis is usually associated with greater symptom burden, greater frequency and severity of exacerbations, more severe airways obstruction and increased mortality risk compared with any of the two diseases alone [ 18 , 25 , 26 ]. Owing to all these reasons, an international group of experts has worked towards achieving a consensus definition of the association of COPD and bronchiectasis independently of the primary diagnosis.…”

The clinical phenotype of bronchiectasis and its clinical guiding implications

“…The COPD bronchiectasis phenotype has special clinical characteristics, such as an excessive sputum volume, a higher risk of bacterial infection, including infection with P. aeruginosa , higher systemic and local inflammatory indexes, more frequent acute exacerbations, poor nutritional status, more severe airflow restriction, and immune imbalance. 17,18 These patients need to be treated for the two situations simultaneously as recommended in the corresponding guidelines. Some scholars have proposed that the area under the forced expiratory flow-volume loop is more suitable for the evaluation of emphysema in patients with bronchiectasis and COPD than the traditional parameters of spirometry and chest CT for guiding follow-up treatment.…”

Antimicrobial Resistance in Common Respiratory Pathogens of Chronic Bronchiectasis Patients: A Literature Review

“…Finally, airway obstruction is the oldest determinant of damages found in bronchiectasis. Laennec [26] identified for the first time this condition, which favors the onset of bronchiectasis in a wide group of conditions including: pulmonary structural alterationstypical of Williams-Campbell syndrome [27], Mounier-Kuhn syndrome [28] and Ehlers-Danlos syndrome [29]-single bronchial obstruction-as in case of neoplasms or foreign bodies-and, finally, obstructive diseases-such as asthma [30], chronic obstructive pulmonary disease (COPD) [31], and alpha-1-antitrypsin deficiency [32].…”