Screening for primary immune deficiency among patients with bronchiectasis
Mylène Dufrénoy1, Luminita Luca1, Vanessa Bironneau2
1Department of Internal Medicine, Poitiers University Hospital, 2, rue de la Milétrie, 86000 Poitiers, France.
Insights
Primary immune deficiency (PID) is often underscreened in bronchiectasis patients. Pneumologists should consider serum immunoglobulin and protein electrophoresis assays for better PID diagnosis and management.
Area of Science:
- Pulmonology
- Immunology
Background:
- Bronchiectasis is a chronic lung condition often associated with increased susceptibility to infections.
- Primary Immune Deficiency (PID) can present with or exacerbate bronchiectasis, necessitating appropriate screening.
Purpose of the Study:
- To evaluate the frequency and methods of PID screening in clinical practice among patients with bronchiectasis.
- To identify factors associated with PID screening and outcomes like recurrent infections.
Main Methods:
- Retrospective analysis of 133 patients with bronchiectasis hospitalized between 2013-2020.
- Assessment of serum immunoglobulin (Ig) assay and serum protein electrophoresis (SPE) utilization.
- Analysis of factors associated with PID diagnosis and antibiotic courses.
Main Results:
- Only 43% of patients received both SPE and Ig assays; 23% received neither.
- Asthma was significantly associated with higher rates of SPE+Ig assay.
- Four patients were newly diagnosed with PID, three with IgG subclass deficiency.
Conclusions:
- Primary immune deficiency is under-screened in patients with bronchiectasis by pulmonologists.
- Combined SPE, Ig assay, and IgG subclass assay is recommended for accurate PID detection.
Introduction:
To assess frequency and methods of PID (primary immune deficiency) screening among patients with bronchiectasis by pneumologists in clinical practice.
Methods:
All the patients hospitalized in the department of pneumology of the Poitiers University Hospital between April 2013 and April 2020 with a diagnosis of bronchiectasis on chest computerized tomography were included. Patients aged 70 and over and those with already known PID were excluded. Primary endpoint was the proportion of patients having had serum immunoglobulin (Ig) assay and serum protein electrophoresis (SPE) analysis. Secondary endpoints were factors associated with prescription of SPE and/or Ig assay, proportion of patients with newly diagnosed PID and their characteristics and factors associated with repeated courses of antibiotics.
Results:
Among the 133 patients included, 43% had SPE+Ig assay, 34% SPE only and 23% neither. The proportion of patients with asthma was higher in the "SPE+Ig assay" group (33.3%) compared to the "SPE only" (11.1%) and the "Neither SPE nor Ig assay" groups (6.4%) (P=0.002). Four patients were newly diagnosed for PID of whom 3 had subclass IgG deficiency. Factors associated with repeated courses of antibiotics were generalized bronchiectasis (P=0.02) and asthma (P=0.04).
Conclusion:
PID is underscreened by pneumologists among patients with bronchiectasis. Association of SPE+Ig assay+IgG subclass assay appears as the most accurate combination.
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