Bronchiectasis More Common in Severe COPD, Pneumonia as Treatment Side Effect

Bronchiectasis More Common in Severe COPD, Pneumonia as Treatment Side Effect

Bronchiectasis becomes more common among patients with chronic obstructive pulmonary disease (COPD) as their disease becomes more severe, and is linked to frequent exacerbations, according to a recent study. Importantly, patients who have both bronchiectasis and COPD are much more likely to develop pneumonia as a side effect of a common treatment with a combination of a long-acting beta agonist and an inhaled corticosteroid.

Based on these findings, researchers suggest that COPD patients should undergo high-resolution computed tomography (CT) chest scans to identify bronchiectasis, a condition present in nearly half of the investigated patients.

The study, Bronchiectasis in Patients With COPD: An Irrelevant Imaging Finding or a Clinically Important Phenotype?  was conducted by scientists from the Metropolitan Hospital in Greece, and was presented at the Chest Annual Meeting 2016.

To study the link between the two lung conditions, which often coexist, researchers retrospectively analyzed the medical records of 855 stable COPD patients who had at least two follow-up visits a year between 2011 and 2015. To be eligible for the study, the records of patients also had to hold information about exacerbations, spirometry measures, and pneumonia incidents.

In this group — with an average age of 66 years and consisting of 59.8% men — bronchiectasis was found in 42.3%. Breaking the statistics up into the four COPD disease stages showed that as COPD severity increased, so did the presence of bronchiectasis; 25%, 36%, 49%, and 59% in stages 1, 2, 3, and 4, respectively.

Among patients with frequent exacerbations — 20.7% of the entire group — bronchiectasis was found in 92.7% of them. In contrast, among the 79.3% who did not have common disease worsening, bronchiectasis was only found in 29.2% of the group.

The majority of the patients, 71.6%, were treated with a long-acting beta-agonist in combination with an inhaled corticosteroid — a treatment physicians often call LABA/ICS. The number of patients with and without bronchiectasis in this treatment group was very similar: 309 and 303 patients, respectively.

In this group, 33 patients had 41 cases of pneumonia. A closer look revealed that 87.9% of those who developed pneumonia had bronchiectasis.

Accordingly, knowledge of a bronchiectasis diagnosis in COPD patients would allow physicians to easier identify those at risk for pneumonia, as well as the likelihood of having more frequent exacerbations.

The study is not alone in linking COPD and bronchiectasis. Late last year, a study found similar links between the conditions, making researchers underscore that the coexistence of these diseases is problematic from a treatment perspective, as some treatments for COPD may not be optimal in bronchiectasis, and vice versa.