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

Background Few 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. Methods We 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. Results Patients 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. Conclusion Patients 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.

[1]  C. Marquette,et al.  Phenotyping Adults with Non-Cystic Fibrosis Bronchiectasis: A 10-Year Cohort Study in a French Regional University Hospital Center , 2016, Respiration.

[2]  W. Guan,et al.  Aetiology of bronchiectasis in adults: A systematic literature review , 2016, Respirology.

[3]  Jian-min Jin,et al.  Bronchiectasis as a Comorbidity of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis , 2016, PloS one.

[4]  G. Sotgiu,et al.  Clinical phenotypes in adult patients with bronchiectasis , 2016, European Respiratory Journal.

[5]  A. Torres,et al.  Etiology of Non-Cystic Fibrosis Bronchiectasis in Adults and Its Correlation to Disease Severity. , 2015, Annals of the American Thoracic Society.

[6]  L. Smeeth,et al.  Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: a population-based cohort study , 2015, European Respiratory Journal.

[7]  J. Chalmers,et al.  A Comprehensive Analysis of the Impact of Pseudomonas aeruginosa Colonization on Prognosis in Adult Bronchiectasis. , 2015, Annals of the American Thoracic Society.

[8]  J. Wedzicha,et al.  Effects of different antibiotic classes on airway bacteria in stable COPD using culture and molecular techniques: a randomised controlled trial , 2015, Thorax.

[9]  A. Nair,et al.  COPD-related Bronchiectasis; Independent Impact on Disease Course and Outcomes , 2014, COPD.

[10]  J. Elborn,et al.  Long-term macrolide maintenance therapy in non-CF bronchiectasis: evidence and questions. , 2014, Respiratory medicine.

[11]  B. Chevalier-Bidaud,et al.  Non specific pattern of lung function in a respiratory physiology unit: causes and prevalence: results of an observational cross-sectional and longitudinal study , 2014, BMC Pulmonary Medicine.

[12]  Kayleigh Kew,et al.  Inhaled steroids and risk of pneumonia for chronic obstructive pulmonary disease. , 2014, The Cochrane database of systematic reviews.

[13]  Stefano Aliberti,et al.  The bronchiectasis severity index. An international derivation and validation study. , 2014, American journal of respiratory and critical care medicine.

[14]  T. Nawrot,et al.  Mortality in non-cystic fibrosis bronchiectasis: a prospective cohort analysis. , 2014, Respiratory medicine.

[15]  A. Anzueto,et al.  Antibiotics for treatment and prevention of exacerbations of chronic obstructive pulmonary disease. , 2013, The Journal of infection.

[16]  L. Hernandez-Aya,et al.  A meta-analysis on the prophylactic use of macrolide antibiotics for the prevention of disease exacerbations in patients with Chronic Obstructive Pulmonary Disease. , 2013, Respiratory medicine.

[17]  G. Kinasewitz,et al.  Bronchial Responsiveness in Patients with Restrictive Spirometry , 2013, BioMed research international.

[18]  J. Lordan,et al.  Phenotyping adults with non-cystic fibrosis bronchiectasis: a prospective observational cohort study. , 2013, Respiratory medicine.

[19]  M. Martínez-García,et al.  Prognostic value of bronchiectasis in patients with moderate-to-severe chronic obstructive pulmonary disease. , 2013, American journal of respiratory and critical care medicine.

[20]  C. Olveira,et al.  Multidimensional approach to non-cystic fibrosis bronchiectasis: the FACED score , 2012, European Respiratory Journal.

[21]  J. Wedzicha,et al.  Changes in prevalence and load of airway bacteria using quantitative PCR in stable and exacerbated COPD , 2012, Thorax.

[22]  F. Martinez,et al.  A Phase 2 Study To Evaluate The Safety, Tolerability And Efficacy Of Levofloxacin Inhalation Solution (MP-376) Administered For 5 Days Every 28 Days To Prevent Acute Exacerbations In High Risk COPD Patients , 2012, ATS 2012.

[23]  M. Martínez-García,et al.  Factors associated with bronchiectasis in patients with COPD. , 2011, Chest.

[24]  M. Habeşoğlu,et al.  Clinical, radiologic, and functional evaluation of 304 patients with bronchiectasis , 2011, Annals of thoracic medicine.

[25]  D Bilton,et al.  British Thoracic Society guideline for non-CF bronchiectasis , 2010, Thorax.

[26]  J. Wedzicha,et al.  Pulsed moxifloxacin for the prevention of exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial , 2010, Respiratory research.

[27]  M. Rodríguez-Carballeira,et al.  Pseudomonas aeruginosa in patients hospitalised for COPD exacerbation: a prospective study , 2009, European Respiratory Journal.

[28]  R. Coll,et al.  Diagnóstico y tratamiento de las bronquiectasias , 2008 .

[29]  R. Negro,et al.  Tobramycin Nebulizer Solution in severe COPD patients colonized with Pseudomonas aeruginosa: effects on bronchial Inflammation , 2008, Advances in therapy.

[30]  J. Soriano,et al.  Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. , 2007, Chest.

[31]  Michael K Gould,et al.  Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition). , 2007, Chest.

[32]  R. Wilson,et al.  Aetiology in adult patients with bronchiectasis. , 2007, Respiratory medicine.

[33]  P. King,et al.  Characterisation of the onset and presenting clinical features of adult bronchiectasis. , 2006, Respiratory medicine.

[34]  R. Wilson,et al.  The effect of Pseudomonas aeruginosa on pulmonary function in patients with bronchiectasis , 2006, European Respiratory Journal.

[35]  A. Oliver,et al.  Antimicrobial therapy for pulmonary pathogenic colonisation and infection by Pseudomonas aeruginosa in cystic fibrosis patients. , 2005, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[36]  J. Wedzicha,et al.  Bronchiectasis, exacerbation indices, and inflammation in chronic obstructive pulmonary disease. , 2004, American journal of respiratory and critical care medicine.

[37]  R. Pauwels,et al.  Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. , 2001, American journal of respiratory and critical care medicine.

[38]  M. Keogan,et al.  An investigation into causative factors in patients with bronchiectasis. , 2000, American journal of respiratory and critical care medicine.

[39]  D. Hansell,et al.  Airflow obstruction in bronchiectasis: correlation between computed tomography features and pulmonary function tests , 2000, Thorax.

[40]  España,et al.  Ley Orgánica 15/1999, de 13 de diciembre, de protección de datos de carácter personal , 1999 .

[41]  S. Kivelä,et al.  Bronchiectasis: an orphan disease with a poorly-understood prognosis. , 1997, The European respiratory journal.

[42]  P. Jones,et al.  Effect of sputum bacteriology on the quality of life of patients with bronchiectasis. , 1997, The European respiratory journal.

[43]  E. Bardana,et al.  Bronchiectasis: update of an orphan disease. , 1988, The American review of respiratory disease.

[44]  D. Navajas,et al.  Spirometric reference values from a Mediterranean population. , 1986, Bulletin europeen de physiopathologie respiratoire.

[45]  C. Olveira,et al.  [Diagnosis and treatment of bronchiectasis. Spanish Society of Pneumology and Thoracic Surgery]. , 2008, Archivos de bronconeumologia.

[46]  C. Olveira,et al.  Diagnosis and Treatment of Bronchiectasis , 2008 .