Patients with both bronchiectasis and rheumatoid arthritis (RA) or chronic obstructive pulmonary disease (COPD) may be at higher risk of mortality, according to results of a new study.
The study, “Bronchiectasis Rheumatoid Overlap Syndrome (BROS) Is An Independent Risk Factor For Mortality In Patients With Bronchiectasis: A Multicentre Cohort Study,” was published in the journal Chest.
RA is an autoimmune disorder characterized by chronic joint inflammation, but it can also be associated with lung complications. Some patients develop both bronchiectasis and RA without interstitial lung disease, an association known as BROS (OS stands for overlap syndrome).
Previous studies have suggested that bronchiectasis has a significantly higher prevalence among RA patients than in the general population. Also, concerns have been raised as to whether patients with BROS may have a worse clinical course than patients with bronchiectasis associated with other health conditions.
To investigate this hypothesis, researchers analyzed the Bronchiectasis Severity Index (BSI, a score index of bronchiectasis) in 1,716 patients from six different centers in European countries. Patients enrolled in the study were divided according to whether they had BROS, idiopathic bronchiectasis, bronchiectasis-COPD overlap syndrome (BCOS), or bronchiectasis associated with other conditions (such as chronic Pseudomonas aeruginosa infection). Data regarding mortality rates, hospitalization, and frequency of exacerbation were analyzed.
Results revealed that 8.5 percent of the patients (147) had BROS. BSI scores were found to be significantly higher in the BCOS group (mean 10.4) and the BROS group (7.7) compared to the other groups. Both BROS and BCOS groups had significantly more exacerbations and prior bronchiectasis-related hospitalizations than the idiopathic bronchiectasis group.
Interestingly, although the BSI score was higher in the BROS group when compared to the idiopathic bronchiectasis group (7.1), this difference was not clinically significantly higher.
The mortality rate over a period of 48 months was 28.5 percent for BCOS, 18 percent for RA, 9.3 percent for idiopathic bronchiectasis, and 8.6 percent for other causes of bronchiectasis. Although mortality was found to be significantly higher among patients with BROS and BCOS compared to other groups, this relationship was not linked to higher rates of bronchiectasis exacerbations or bronchiectasis-related hospitalizations.
“The current data support the premise that BROS patients are at higher risk of premature death and a multidisciplinary approach involving chest and rheumatology physicians is needed,” the researchers concluded. “Patients with BROS with ‘mild’ bronchiectasis defined radiologically by extent or by using composite scoring systems may need closer monitoring than those with other [factors] causing bronchiectasis.”