Bronchiectasis in Japanese patients with chronic obstructive pulmonary disease: A prospective cohort study

Bronchiectasis often coexists with chronic obstructive pulmonary disease (COPD) and is associated with worse clinical outcomes than COPD alone. However, there is limited evidence on Japanese patients with COPD. This study aimed to investigate the prevalence, clinical characteristics, and outcomes of bronchiectasis in Japanese patients with COPD.

This prospective observational study included a cohort of Japanese patients with COPD between April 2018 and January 2025. Patient characteristics, exacerbation frequency, and mortality were assessed over a 5-year follow-up period. The Cox proportional hazards model was used to evaluate the association between bronchiectasis and mortality.

In total, 302 patients (287 males, 15 females; median age, 76 years) with stable COPD were enrolled, 15 % of whom had radiological bronchiectasis, and 3.3 % had ≥3 lobes involved or cystic bronchiectasis. Patients with COPD and bronchiectasis were older and had higher staging. No significant differences were observed in exacerbations or mortality rates between patients with and without bronchiectasis. Among patients with COPD and bronchiectasis, all-cause mortality was associated with airflow obstruction (hazard ratio [HR], 0.96; 95 % confidence interval [CI], 0.92-0.99), dyspnea (HR, 2.2; 95 %CI, 1.3-3.6), health status (HR 1.1; 95 %CI, 1.0-1.3), bronchiectasis severity index (HR, 1.3; 95 %CI, 1.1-1.6), and positive Pseudomonas aeruginosa culture (HR 6.7; 95 %CI, 1.3-33).

These findings demonstrated that radiological bronchiectasis was not associated with poor clinical outcomes within 5 years of follow-up. Among patients with COPD and bronchiectasis, mortality was associated with symptoms, disease severity, and positive Pseudomonas aeruginosa cultures.

This study was registered in the UMIN Clinical Trials Registry (UMIN000032112).