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Bronchiectasis in Severe Asthma: Does It Make a Difference?
Sarah Alice Bendien1, Stephanie van Loon-Kooij2, Gerdien Kramer3
1Department of Respiratory Medicine, Haga Teaching Hospital, The Hague, The Netherlands, s.vannederveen@hagaziekenhuis.nl.
Respiration; International Review of Thoracic Diseases
|December 15, 2020
Summary
Patients with severe asthma and bronchiectasis have distinct characteristics, including lower lung function and more infections. Identifying this severe asthma subgroup with bronchiectasis may improve treatment and outcomes.
Area of Science:
- Pulmonology
- Respiratory Medicine
- Clinical Science
Background:
- Asthma and bronchiectasis frequently coexist, especially in severe asthma cases.
- Co-diagnosis impacts treatment decisions and patient outcomes.
- Previous studies on asthma with bronchiectasis show varied results due to cohort heterogeneity.
Purpose of the Study:
- To investigate if bronchiectasis contributes to asthma severity.
- To identify distinct characteristics and treatable traits in patients with severe asthma and bronchiectasis.
- To explore the prevalence of bronchiectasis in specific severe asthma phenotypes.
Main Methods:
- Single-center study of patients with severe asthma (ATS/ERS guidelines).
- Defined asthma and infectious exacerbations requiring systemic steroids or antibiotics.
- High-resolution computed tomography (HRCT) evaluated by blinded radiologists.
Main Results:
- 19% of severe asthma patients had bronchiectasis.
- Bronchiectasis associated with lower FEV1% predicted, lower FEV1/FVC, and more infectious exacerbations.
- Higher bronchiectasis prevalence in adult-onset, eosinophilic asthma; linked to specific microbial findings (e.g., P. aeruginosa, A. fumigatus).
Conclusions:
- Severe asthma patients with bronchiectasis form a distinct subgroup.
- This subgroup shows differences in disease severity, microbiology, and phenotype.
- HRCT and sputum cultures aid in identifying these patients for targeted treatment.
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