Patients with asthma, or with rhinosinusitis, also risk more extensive bronchiectasis disease, affecting multiple lobes of the lung. That is why researchers conducting the study believe asthma should be considered in the diagnosis and treatment of bronchiectasis patients.
Bronchiectasis is a rare lung disease that has historically been “under-researched and under-resourced,” researchers wrote. In the U.S., bronchiectasis prevalence was estimated to be from 53 to 566 cases per 100,000 inhabitants in 2005, with the prevalence increasing in females and older people.
But now bronchiectasis is recognized as a illness urgently in need of better treatments, better clinical care, and more clinical and translational research.
In the study, a team led by researchers at the University of Helsinki and Helsinki University Hospital, in Finland, examined the factors causing bronchiectasis and increasing the risk of more severe disease among Helsinki residents.
The study was done in collaboration with the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC), a European network whose goal is to facilitate collaborative research in non-cystic fibrosis bronchiectasis. This network has created a list of bronchiectasis patients across Europe, called the EMBARC registry.
The study included 95 adult bronchiectasis patients recruited between 2016 and 2018 in three hospitals covering Helsinki’s area. Mean age of participants was 69 years, and most were women (79%).
Clinical characteristics, lung function and imaging, microbiological, and therapeutic data were entered into the EMBARC database.
In the majority of patients analyzed (68%), asthma was an accompanying (comorbid) condition. In fact, for about one quarter (26%) of these patients, asthma had been diagnosed prior to bronchiectasis, indicating that it actually could be the cause of their bronchiectasis.
For patients whose asthma was the cause of bronchiectasis, there was a mean of 18.5 years between the diagnosis of asthma and bronchiectasis.
For the remaining patients, bronchiectasis cause was unknown in 41% (idiopathic), or due to an infection in 11%. In a few others, the disease was associated with rheumatic disease, Sjögren syndrome, Alpha-1-antitrypsin deficiency, IgG deficiency, and Kartagener syndrome.
Cystic fibrosis was associated with bronchiectasis in 9.4% of the patients.
Most common comorbidities besides asthma in this patient group were cardiovascular disease (30%), gastroesophageal reflux disease (26%), overweight (22%), diabetes (16%), inactive neoplasia (tumor; 15%), immunodeficiency (12%), depression (10%), and anxiety (4%).
Most of the patients studied (68%) had extensive bronchiectasis, having four or more lobes of the lungs affected.
The data revealed that patients with asthma — either as a cause or as an accompanying complication — or patients with rhinosinusitis (a chronic inflammation of the cavities around the sinuses) were at higher risk of extensive bronchiectasis.
Taken together, the results underscored asthma as a common cause of bronchiectasis in Finland.
Compared to other European countries — including Greece, France, and Spain — asthma in Finland was considered five to 10 times more often as a cause of bronchiectasis (26% versus 2.5, 4, and 5.4%, respectively). These discrepancies might be explained by regional differences in the diagnosis of both asthma and bronchiectasis.
Of note, in the U.S. Bronchiectasis Registry, asthma was found as a comorbidity in 29% of the patients.
Overall, the data suggests that asthma “is common as etiology [disease cause] and comorbidity in BE [bronchiectasis], and should be considered in diagnostics and treatment,” researchers wrote.
This is particularly important because bronchiectasis “in association with asthma has been reported to carry a poorer survival and a greater exacerbation rate than asthma alone” they added.