Impact of Bronchiectasis Severity on Clinical Outcomes in Patients With Allergic Bronchopulmonary Aspergillosis: A Retrospective Cohort Study
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Inderpaul S Sehgal1, Valliappan Muthu1, Sahajal Dhooria1
1Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Background:
The impact of bronchiectasis severity on the outcomes of patients with allergic bronchopulmonary aspergillosis (ABPA) remains uncertain.
Objective:
To evaluate whether bronchiectasis severity is associated with an increased risk of ABPA exacerbations.
Methods:
We retrospectively analyzed patients with ABPA between 2007 and 2019. Patients were categorized based on the segments involved by bronchiectasis as mild (1-5), moderate (6-9), and extensive (≥10). We compared lung function and immunological markers among the groups. A multivariable Poisson regression analysis, using follow-up duration as an offset variable, assessed the association between bronchiectasis severity and ABPA exacerbations, adjusting for key confounders. We report the association as an adjusted relative rate (aRR) with 95% confidence intervals (CI).
Results:
We included 705 patients with ABPA (mean age, 35 years). Of these, 219 (31.1%), 226 (32.1%), and 260 (36.9%) had mild, moderate, and extensive bronchiectasis, respectively. Patients with extensive bronchiectasis had poorer lung function and elevated immunological markers (serum total IgE, Aspergillus fumigatus-IgE, and A. fumigatus-IgG) than those with mild or moderate bronchiectasis. The exacerbation frequency increased with the severity of bronchiectasis (mild: 41.5% vs moderate: 53.4% vs extensive: 57.7%, P = .005). On multivariable analysis, the risk of ABPA exacerbation increased significantly with bronchiectasis severity (aRR [95% CI]; extensive: 1.51 [1.09-2.08], moderate: 1.50 [1.09-2.08]). In addition, increasing age (aRR, 0.84 [95% CI, 0.76-0.94]) and body mass index (aRR, 0.97 [95% CI, 0.94-0.99]) were associated with lower exacerbation risk after adjusting for total IgE, lung function, and high-attenuation mucus.
Conclusion:
Moderate-to-extensive bronchiectasis is associated with worse lung function, heightened immunological severity, and an increased risk of ABPA exacerbation.
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