Patterns of Disease in Patients with Middle-Lobe Predominant Bronchiectasis
Melissa J McDonnell1, Mohammed Ahmed, Jeeban Das
1Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.
Background:
Middle-lobe predominant bronchiectasis affecting the right middle-lobe and/or lingula (RMLP) is classically described in asthenic, elderly females with skeletal abnormalities or associated nontuberculous mycobacterial (NTM) infection.
Objectives:
We aimed to evaluate the frequency and clinical characteristics of patients with an RMLP phenotype in a cohort of newly diagnosed bronchiectasis patients and determine associations with disease severity.
Methods:
A retrospective observational cross-sectional cohort study of consecutive bronchiectasis patients in our institution was performed. Data were collected on baseline variables, microbiology status, lung function, and radiology according to the modified Bhalla score. Disease severity was assessed using bronchiectasis severity index (BSI) and FACED severity scores.
Results:
Of 81 patients (mean age [SD] 62.6 [12.4], females 55 [67.9%], BMI 26.9 [5.7%]), 20 (24.7%) had RMLP disease. These patients were significantly younger, female, and with lower BMIs than patients with the classical bronchiectasis phenotype (p = 0.03, 0.01, and p <0.01, respectively). Fewer symptoms of cough and daily sputum (p = 0.01 and <0.01), prior exacerbation frequency (p = 0.03), and higher baseline forced expiratory volume (p = 0.04) were noted. A higher incidence of NTM at diagnosis was demonstrated (p = 0.01). BSI and FACED severity scores in RMLP patients were significantly lower than their counterparts (both p < 0.001).
Conclusions:
The RMLP phenotype is associated with younger patients than classically described in the literature. An increased rate of NTM infection in this phenotype was noted, particularly in females, but much lower than previously described. Lung function and disease severity scores in this patient group are relatively normal, suggesting a milder phenotype in patients with this form of the disease.
Insights
The right middle-lobe predominant (RMLP) bronchiectasis phenotype appears in younger patients than previously thought. This RMLP bronchiectasis group shows milder disease and normal lung function, with a notable increase in nontuberculous mycobacterial (NTM) infection.
Area of Science:
- Pulmonology
- Medical Research
- Clinical Epidemiology
Background:
- The right middle-lobe and/or lingula predominant (RMLP) bronchiectasis phenotype is classically associated with elderly, asthenic females, often with skeletal abnormalities or nontuberculous mycobacterial (NTM) infection.
- This presentation challenges the traditional understanding of RMLP bronchiectasis demographics and associations.
Purpose of the Study:
- To determine the frequency and clinical characteristics of the RMLP bronchiectasis phenotype in newly diagnosed patients.
- To assess the association between the RMLP phenotype and bronchiectasis disease severity.
Main Methods:
- A retrospective observational cohort study of 81 consecutive bronchiectasis patients.
- Data collection included baseline variables, microbiology, lung function, and radiology (modified Bhalla score).
- Disease severity was evaluated using the bronchiectasis severity index (BSI) and FACED scores.
Main Results:
- 20.7% of patients exhibited the RMLP phenotype.
- RMLP patients were younger, more frequently female, and had lower BMIs compared to classical bronchiectasis patients.
- The RMLP group showed fewer symptoms, lower exacerbation rates, better baseline lung function, a higher incidence of NTM, and significantly lower BSI and FACED scores.
Conclusions:
- The RMLP bronchiectasis phenotype is observed in younger individuals than previously documented.
- While NTM infection is more common in this group, particularly in females, its incidence is lower than reported in older literature.
- Patients with the RMLP phenotype generally present with milder disease and relatively normal lung function.
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