Bronchiectasis May Predict Mortality in COPD

A recent review of several studies showed that the presence of bronchiectasis may lead to more exacerbations and other problems for patients with chronic obstructive pulmonary disease (COPD).

The study, conducted by Qingxia Du of the Department of Respiratory Medicine and the Department of Emergency at Beijing Tongren Hospital at Capital Medical University in Beijing China, and colleagues, was published on PLOS One on March 15, 2016.

The researchers described why they undertook the review with, “Given the potentially important impact of coexistent bronchiectasis on COPD outcomes, we summarized the current data from observational cohort studies to investigate the association between bronchiectasis and COPD.” In order to carry out their investigation, they used a combination of the search terms “COPD,” “chronic obstructive pulmonary disease,” and “bronchiectasis.” They further refined the results by applying specific inclusion and exclusion criteria.

“The outcomes are risks of COPD exacerbations, isolation of a PPM, [potentially pathogenic microorganisms], severe airflow obstruction and overall mortality,” said the researchers. A total of 14 studies met the criteria to be included, and those 14 contained data for 5329 COPD patients. Of those, 1572, or 29.5%, also had bronchiectasis.

The researchers note that “All these studies were observational cohorts, and thus there were limitations in the interpretation of causality and in methodologies.” Seven of the studies had small populations, and the researchers said, “Most studies lacked adjustment for potential confounders.” Even with those limitations the researchers reached some conclusions.

Bronchiectasis is a common finding in computed tomography (CT) scans of COPD patients, and rather than simply being “mere radiological findings” say the researchers, it could have “a real impact on the natural history of COPD itself and could be of prognostic value in the evaluation and management of the disease.”

For example, COPD patients with bronchiectasis are more likely to experience exacerbations. It is more likely that PPMs will be present, and patients may have more severe airflow obstruction than those without bronchiectasis. Additionally, bronchiectasis may increase overall mortality among COPD patients. In fact, the researchers say, “The association between the presence of bronchiectasis and COPD mortality is a remarkable finding of our study.”

The researchers suggest that “well designed prospective studies are clearly needed to explore the clinical significance of detection of bronchiectasis.” They also recommend that higher-quality, longer-term studies could explain the relationship between bronchiectasis and COPD outcomes.