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

Abstract

IntroductionThe coexistence of chronic obstructive pulmonary disease (COPD) and bronchiectasis (BE) seems to be common and associated with a worse prognosis than for either disease individually. However, no definition of this association exists to guide researchers and clinicians.MethodsWe conducted a Delphi survey involving expert pulmonologists and radiologists from Europe, Turkey and Israel in order to define the “COPD-BE association”.A panel of 16 experts from EMBARC selected 35 statements for the survey after reviewing scientific literature. Invited participants, selected on the basis of expertise, geographical and gender distribution, were asked to express agreement on the statements. Consensus was defined as a score of ≥6 points (scale 0 to 9) in ≥70% of answers across two scoring rounds.ResultsA-hundred-and-two (72.3%) out of 141 invited experts participated the first round. Their response rate in the second round was 81%. The final consensus definition of “COPD-BE association” was: “The coexistence of (1) specific radiological findings (abnormal bronchial dilatation, airways visible within 1 cm of pleura and/or lack of tapering sign in ≥1 pulmonary segment and in >1 lobe) with (2) an obstructive pattern on spirometry (FEV1/FVC<0.7), (3) at least two characteristic symptoms (cough, expectoration, dyspnoea, fatigue, frequent infections) and (4) current or past exposure to smoke (≥10 pack-years) or other toxic agents (biomass, etc.)”. These criteria form the acronym “ROSE” (Radiology, Obstruction, Symptoms, Exposure).ConclusionsThe Delphi process formulated a European consensus definition of “COPD-BE association”. We hope this definition will have broad applicability across clinical practice and research in the future.

Bronchiectasis exacerbation: a narrative review of causes, risk factors, management and prevention

“…In a Chinese study of 249 patients with only bronchiectasis and 214 with both bronchiectasis and asthma, the presence of asthma was independently associated with bronchiectasis exacerbation (OR, 2.60; 95% CI, 1.15–5.88; P=0.021) ( 50 ). Efforts have been made to define the association between COPD and bronchiectasis, because the interaction between the two diseases is complex ( 51 , 52 ). Despite this complexity, patients with COPD-associated bronchiectasis have an increased frequency of exacerbation compared to those with bronchiectasis not associated with COPD across multiple cohorts ( 19 , 53 ).…”

Bronchiectasis and Other Chronic Airway Diseases: A Clinical-based Approach

“…For instance, despite its high prevalence in BE patients, the functional obstructive pattern could suggest co-existing COPD in case of known toxic exposures (tobacco, etc.) 50 .…”

“…A recent Delphi survey of European experts has described the association of COPD and BE as the combination of 1) radiological findings (CT scan), 2) obstructive pattern (spirometry), 3) compatible symptoms and 4) exposure to smoke (≥ 10 pack-years) or other toxic agents (biomass, etc.) 50 . Although the definition has not been validated in clinical cohorts it seems a useful tool to guide clinicians in identification of patients with this frequent association.…”

The Impact of Chronic Bronchial Infection in COPD: A Proposal for Management

“… 71 Fourth, the importance of performing a CT scan for the diagnosis of associated bronchiectasis due to the clinical, prognostic and therapeutic repercussions of the combination of the two diseases must be demonstrated. 52 , 72 Fifth, trials aimed at the study of the safety and efficacy of treatments for CBI in patients with COPD and frequent exacerbations must be designed.…”