Severe Asthma Patients with Bronchiectasis at Increased Risk of Hospitalization, Other Issues, Study Finds

Severe Asthma Patients with Bronchiectasis at Increased Risk of Hospitalization, Other Issues, Study Finds

Patients with both severe asthma and bronchiectasis are at more risk of frequent hospitalization, gastroesophageal reflux disease, hypersensitivity to nonsteroidal anti-inflammatory drugs, and higher blood eosinophil counts than patients who only have severe asthma, a study shows.

The study, “Bronchiectasis in severe asthma: Clinical Features and Outcomes,” was published in the journal Annals of Allergy, Asthma, and Immunology.

Severe asthma, despite only accounting for 5 to 10 percent of asthma cases, disproportionately contributes to asthma-related healthcare costs. Identifying other conditions that occur most often with asthma is important because they can contribute to poor disease control.

Bronchiectasis — defined as an irreversible dilation of the airways — is frequently associated with asthma, reported in 17.5 to 80 percent of asthma cases.

Researchers set out to retrospectively investigate the prevalence of bronchiectasis in a group of patients with severe asthma, and to determine the characteristics and outcomes of these patients in regards to exacerbation rates and hospitalizations.

The team reviewed the medical reports of 184 patients with confirmed severe asthma who underwent high-resolution computed tomography (CT) scanning of the chest and lungs.

Clinical data indicated that bronchiectasis was present in 86 of those patients (47%). Patients with both severe asthma and bronchiectasis had 2.24 times higher hypersensitivity to nonsteroidal anti-inflammatory drugs — such as aspirin — and a 1.89 times higher risk of gastroesophageal reflux disease than patients without bronchiectasis.

Patients with both diseases also had a more than fivefold lower risk of atopic dermatitis — a condition that makes the skin red and itchy — than patients without bronchiectasis.

Furthermore, patients with severe asthma and bronchiectasis had a more than twofold higher hospitalization rate for asthma exacerbations, as well as higher blood eosinophil levels — a type of immune cell.

“Our study suggests that in subjects with severe asthma, the presence of bronchiectasis is associated with more frequent hospitalizations, concomitant gastroesophageal reflux disease, hypersensitivity to nonsteroidal anti-inflammatory drugs, and higher blood eosinophil counts,” the researchers wrote.

They suggest that given the high levels of eosinophils in these patients, bronchiectasis could represent a clinical feature of severe eosinophilic asthma — a more severe form of asthma.

As the full extent of eosinophils in this type of asthma is not yet understood, further studies should be conducted to determine their role in order to better guide treatment approaches.

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