Half of newly diagnosed patients with bronchiectasis in the U.S. also have chronic obstructive pulmonary disease (COPD), associated with a history of smoking and a higher number of hospitalizations, according to a recent study.
These findings highlight the need for additional studies to understand the differences between bronchiectasis patients with and without COPD.
Bronchiectasis is an increasingly common chronic disease, but its true prevalence is still difficult to estimate, partly because of its diversity and the lack of appropriate screening. Recent estimates have suggested that the incidence of bronchiectasis has surpassed the threshold for a rare disease in the U.S., defined as a disease affecting less than 200,000 people.
Bronchiectasis and COPD — a group of progressive lung diseases characterized by increasing breathlessness — are frequently overlapping diagnoses. Previous studies have reported that 20-52% of bronchiectasis patients have overlapping COPD, and that the prevalence of bronchiectasis in COPD patients increases with age.
Several studies have suggested that patients with both illnesses tend to have poorer respiratory function, more frequent exacerbations or flares, more hospitalizations, and higher mortality rates. For these patients, appropriate evaluations to confirm the primary underlying disease and the severity of each are needed, because finding the right treatment depends on it.
However, the relationship between the two conditions and the importance of the dual diagnosis remains unclear.
Researchers have now evaluated the prevalence and characteristics of people older than 65 who had been newly diagnosed with bronchiectasis in the U.S., using data from Medicare between 2006 and 2014.
They found that the average annual prevalence of bronchiectasis in the U.S. during 2012-2014 was 701 per 100,000 people, which they noted was higher than previously reported.
From a total of 252,043 patients older than 65 at the time of bronchiectasis diagnosis, 175,572 (69.7%) were newly diagnosed. These patients’ mean age was 76, and most of them were women (64.6%) and predominantly non-Hispanic white (84.2%).
Of these newly diagnosed bronchiectasis patients, 51% (89,958 people) were also diagnosed with COPD. Compared with bronchiectasis patients without a COPD diagnosis, patients with a dual diagnosis were significantly more likely to have a history of smoking (46.3% versus 16.7% in patients with bronchiectasis only), asthma (40.3 versus 15.7%), as well as higher hospitalization rates (1.52% versus 0.91%).
Patients with both bronchiectasis and COPD also had more indicators of poorer health, namely an increased use of antibiotics, corticosteroids, bronchodilators, and oxygen therapy, and more respiratory infections and physician office visits than patients with bronchiectasis only.
Researchers also found that patients diagnosed at an older age “may be more likely to have bronchiectasis caused by repeated infections or COPD than an underlying genetic predisposition,” they said.
They also noted that half of newly diagnosed patients had no record of treated acute respiratory infections in the previous year, suggesting there may be a large group of people with bronchiectasis that have no symptoms.
The team concluded that half of newly diagnosed bronchiectasis patients also have COPD, which is “associated with poorer health indicators and higher utilization” of healthcare resources.
Considering the study identified more than 250,000 Medicare patients with a bronchiectasis diagnosis over a nine-year period, they highlighted that “bronchiectasis is likely no longer an “orphan” disease in the U.S. and the burden of disease in the aging population deserves further attention.”