Bronchiectasis finding reveals COPD patients at mortality risk

Bronchiectasis is independently associated with mortality risk among patients with moderate-to-severe chronic obstructive pulmonary disease (COPD), Spanish research shows.

The study authors say the finding could mean the identification of patients early in the course of COPD who are suitable for preventive antibiotic treatment.

"If the prognostic value of bronchiectasis in patients with moderate-to-severe COPD that we found is confirmed in further and larger studies, it would have an important clinical impact," said author Miguel-Angel Martinez-Garcia (Polytechnic and University La Fe Hospital, Valencia) in a press statement.

"Brochiectasis can be reliably diagnosed with high-resolution CT [computed tomography] scanning, and effective treatments are available, potentially reducing the risk of mortality in patients with COPD."

The study included 201 patients diagnosed with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II-IV disease between 2004 and 2007. After the use of high-resolution CT to detect bronchiectasis initially, patients were followed up every 3-6 months until July 2010.

Overall, 115 (57.2%) patients presented with bronchectasis. These patients had more severe COPD (mean post-bronchodilatory forced expiratory volume in 1 second [FEV₁], 1249 vs 1480 mL), and were significantly more likely to have potentially pathogenic microorganism isolates in their sputum than were patients without bronchiectasis (59.1 vs 20.0%).

Over a median follow up of 48 months, 51 (25.4%) patients died, 43 (84.3%) of whom had bronchiectasis. Multivariate analysis showed that the risk for death among COPD patients with bronchiectasis was 2.54 times that for patients without.

Greater age, lower post-bronchodilator FEV₁, and a higher Charlson comorbidity Index score were also significantly and independently associated with poorer prognosis.

The authors say that bronchiectasis is associated with longer, more intense exacerbations, more frequent bacterial colonization of the bronchial mucosa, and a greater degree of functional impairment, which are all known to predict poor outcome in COPD. However, the direct association between the condition and COPD mortality has never been explored.

"The prognostic value of the presence and severity of bronchiectasis could suggest the existence of a new phenotype of COPD patients with bronchiectasis, probably related to the exacerbation and chronic bronchitis phenotypes," conclude Martinez-Garcia and colleagues in the American Journal of Respiratory and Critical Care Medicine.

"The pathogenic vicious circle of infection-inflammation leading to the formation of bronchiectasis can probably be broken by the early identification of this subgroup of patients with COPD and bronchiectasis and the establishment of early treatment, probably focusing on bronchial colonization by [potentially pathogenic microorganisms]."

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