The review, “Bronchiectasis As A Comorbidity Of Chronic Obstructive Pulmonary Disease: Implications And Future Research,” was conducted by Ya-Hong Chen and Yong-Chang Sun from Peking University Third Hospital in China.
COPD is a lung disease with high morbidity and mortality. Several studies have suggested that bronchiectasis may contribute to the outcome of patients with COPD. Patients with moderate to severe COPD and bronchiectasis have more severe symptoms, higher exacerbation frequency, and increased mortality.
In 2014, bronchiectasis was included as a disease in the realm of COPD by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Knowing the prognostic implications of bronchiectasis in COPD patients, early detection of bronchiectasis could contribute to better management of the condition and improve survival.
Currently, the global prevalence of bronchiectasis in COPD patients is likely high, but not really known due to different inclusion criteria, different GOLD stages, or differing definitions of bronchiectasis itself. For example: In a study from Spain, bronchiectasis was found in 57.6% of patients with moderate to severe COPD, while a Turkish study reported prevalence at 33%, and a recent U.K. study showed that 69% of COPD patients with acute exacerbation had some evidence of bronchiectasis.
“Evaluation of [the study] COPD Longitudinally to Identify Predictive Surrogate Endpoints revealed a prevalence of bronchiectasis in 4% of COPD patients with all GOLD stages, but much higher prevalence of bronchiectasis in COPD patients was reported, ranging from 20% to 58% in both primary and secondary care,” the authors wrote in the study review report.
It is suggested that bronchiectasis more often affects older male COPD patients who smoke or have smoked. Those patients have symptoms that last longer, they rank poorly in nutritional status, and they display larger amounts of yellow or green sputum (mucus) coughed up from diseased lungs.
According to the authors, bronchiectasis may also increase the risk of community-acquired pneumonia in COPD patients.
Two types of clinical status among COPD patients with bronchiectasis exist: mild bronchiectasis but with severe emphysema (and also shortness of breath and lower exercise tolerance), and diffuse bronchiectasis associated with bronchial wall thickening (patients may present frequent exacerbations and daily sputum production). Although there are scores to evaluate bronchiectasis severity, more studies are needed for patients with and without COPD.
“There is no consensus about the management strategies for COPD coexistent with bronchiectasis”, the authors wrote. “Treatments beneficial in COPD may not be so in bronchiectasis and vice versa. Inhaled corticosteroids are widely used in COPD but not recommended in most patients with bronchiectasis. GOLD strategy suggested that treatment of bronchiectasis in patients with COPD should be along conventional lines for bronchiectasis with the addition of usual COPD strategies where indicated.”
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