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The Association between Bronchiectasis and Chronic Obstructive Pulmonary Disease: Data from the European
Eva Polverino1,2, Anthony De Soyza3, Katerina Dimakou4
1Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Barcelona, Spain.
American Journal of Respiratory and Critical Care Medicine
|January 25, 2024
Summary
Many patients with bronchiectasis are incorrectly diagnosed with chronic obstructive pulmonary disease (COPD). Applying objective criteria reveals that a significant portion lacks key COPD indicators, impacting clinical outcomes and disease management.
Area of Science:
- Pulmonology
- Respiratory Medicine
- Clinical Epidemiology
Background:
- Chronic obstructive pulmonary disease (COPD) and bronchiectasis frequently coexist.
- Discrepancies in diagnostic criteria affect understanding of their combined impact on patient outcomes.
- Objective definitions are needed to clarify the association between these conditions.
Purpose of the Study:
- To determine the prevalence of chronic obstructive pulmonary disease (COPD) in patients with bronchiectasis.
- To evaluate the relationship between this co-diagnosis and clinical outcomes.
- To assess the utility of the standardized ROSE criteria for objectively defining COPD in bronchiectasis patients.
Main Methods:
- Analysis of data from the European Bronchiectasis Registry (EMBARC), a prospective observational study.
- Inclusion of 16,730 patients with computed tomography-confirmed bronchiectasis from 28 countries.
- Application of the ROSE criteria (Radiological bronchiectasis, Obstruction, Symptoms, Exposure) to define COPD association.
Main Results:
- A clinician-assigned COPD diagnosis was present in 4,336 patients, associated with more exacerbations and worse quality of life.
- Overdiagnosis of COPD was observed, with 22.2% lacking airflow obstruction and 31.9% lacking sufficient smoking history.
- The ROSE criteria identified 2,157 patients (55.4%) as having COPD associated with bronchiectasis, showing increased risks of exacerbations and hospitalizations.
Conclusions:
- The COPD diagnosis in bronchiectasis patients is frequently based on subjective criteria, lacking objective evidence of obstruction or smoking history.
- Patients labeled with COPD but not meeting objective criteria still exhibit worse clinical outcomes.
- Standardized criteria like ROSE are crucial for accurate diagnosis and understanding the true impact of COPD in bronchiectasis.
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