Bronchiectasis in chronic obstructive pulmonary disease (COPD) patients is associated with a notably higher risk of acute respiratory flares and other serious problems, a Taiwan study shows, and its researchers emphasized that doctors need to be aware of such comorbidities when treating these people.
The study, “Acute respiratory events in patients with bronchiectasis–COPD overlap syndrome: A population-based cohort study,” was published in the journal Respiratory Medicine.
Bronchiectasis and COPD can coexist in a person, a condition called bronchiectasis-COPD overlap syndrome (BCOS). A few studies have shown that patients with both illnesses tend to have poorer respiratory function and more frequent exacerbations or flares.
Best ways of managing BCOS and likely patient outcomes, however, are still being investigated.
Clinical practice guidelines in the Global Initiative for COPD, for instance, do not include recommendations regarding BCOS. Larger, multicenter studies are needed to evaluate potential outcomes and treatment and disease management choices for these patients.
Researchers in Taiwan conducted a nationwide, population-based cohort analysis to compare acute respiratory events in patients with both bronchiectasis and COPD and in COPD patients without bronchiectasis.
The study included information on 3,955 people with COPD and bronchiectasis, diagnosed from 2000 to 2007. As a comparison, data on 15,802 people with COPD but not bronchiectasis, matched by age and sex, were also used. All patients were registered in the Taiwan Longitudinal Health Insurance database.
The two groups were followed for five years, and the team examined the incidence and risk of acute respiratory events that required emergency room visits or hospitalizations, including pneumonia, acute flares, acute respiratory failure, and cardiopulmonary arrest.
Such acute events were more common in BCOS patients than in COPD patients — 16.4 versus 5.52 events per hundred people per year, respectively.
Researchers found that bronchiectasis in COPD patients consistently raised the risk of acute respiratory problems, regardless of a person’s age, sex, or other comorbidities, including cancer, autoimmune diseases, stroke, diabetes, heart failure, or tobacco use.
Specifically, people with BCOS had a 3.88-fold higher risk of an acute exacerbation, a 2.2-fold higher risk of pneumonia, a 1.99-fold higher risk of cardiopulmonary arrest, and a 1.74-fold higher risk of acute respiratory failure than did COPD patients without bronchiectasis.
Higher rates of infection with Pseudomonas aeruginosa — a difficult to treat bacteria — were also found in COPD patients with bronchiectasis (1.62%) compared to those without this comorbidity (0.97%).
The link between bronchiectasis and acute respiratory problems is not entirely clear, but the researchers suggested several reasons: more severe impairment of airflow due to airway wall thickening and airway dilatation or enlargement, increased trapping of pathogenic bacteria or fungi, and aggravated bronchial inflammation.
Researchers advised that “the isolation of P. aeruginosa may help clinicians to conduct a preliminary assessment of bronchiectasis for further treatment programs such as bronchopulmonary hygiene therapy, infection treatment, and pulmonary rehabilitation.”
Treatment with antibiotics should be done for shorter periods in COPD patients and with caution, given the possibility of antimicrobial resistance, they added.
Overall, “the results of this study demonstrate that the patients with BCOS had a higher risk of acute respiratory events than did the COPD patients without bronchiectasis,” the researchers concluded. “Clinicians should be aware of this epiphenomenon and prescribe appropriate treatment for patients with concomitant COPD and bronchiectasis.”
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