Smoking, pulmonary hypertension, and a decline in lung function are associated with an increased risk of death in people with chronic obstructive pulmonary disease (COPD). Now researchers in Spain have added another potential risk factor: the presence and severity of bronchiectasis.
Compared with unaffected patients with COPD, patients with bronchiectasis had more than double the risk of dying than those without, according to a prospective, observational study published online February 8 in the American Journal of Respiratory and Critical Care Medicine.
Miguel Angel Martínez-García, MD, from the Pneumology Service at the University and Polytechnic La Fe Hospital in Valencia, Spain, and colleagues assessed 201 participants with moderate to severe COPD from a consecutive series of outpatients diagnosed at 1 of 2 specialty clinics in Spain. The mean age of participants was 70 years, and 91% were men. A majority (77%) featured radiologic signs of emphysema. Patients were diagnosed between January 2004 and February 2007.
"Patients with bronchiectasis in our series were 2.5 times more likely to die than those without bronchiectasis, independently of other variables," the researchers write.
Of the participants, 115 (57%) presented with bronchiectasis, which is defined "as a permanent and progressive dilation of the airways." The researchers followed up the participants every 3 to 6 months for a median of 48 months. Mortality risk among these patients with bronchiectasis was higher compared with that for the 86 unaffected patients (unadjusted hazard ratio, 4.07; 95% confidence interval, 1.9 - 8.7; P = .0001).
Bronchiectasis remained an independent factor after adjustment for dyspnea (Medical Research Council Dyspnea Scale), partial pressure of oxygen, body mass index, presence of potentially pathogenic microorganisms in sputum, presence of daily sputum production, number of severe exacerbations and peripheral albumin, and ultrasensitive C-reactive protein concentrations (adjusted hazard ratio, 2.54; 95% confidence interval, 1.16 - 5.56; P = .02). Age, Charlson Index, and postbronchodilator forced expiratory volume in 1 second (%) were also significantly associated with mortality in the adjusted model.
"The results of this study confirm a high prevalence of bronchiectasis in moderate-to-severe COPD patients and suggest that bronchiectasis is independently associated with an increased risk of all-cause mortality in these patients," the authors write.
The 51 deaths during follow-up were attributed to respiratory causes (32 patients), cardiovascular disease (11), malignant disease (5), and other causes (3 patients). Other factors that can influence mortality in patients with COPD were not assessed (eg, inactivity or pulmonary hypertension), which is a limitation of the study.
Use of bronchiectasis as a new factor for prognosis would "have a major clinical impact," the authors note. Detection of bronchiectasis with high-resolution computed tomography scans is reliable, and, once identified, patients can be treated with effective therapy to combat the chronic bronchial inflammation and infection.
"The pathogenic vicious circle of infection-inflammation leading to the formation of bronchiectasis can probably be broken by the early identification of this subgroup of patients with COPD and bronchiectasis and the establishment of early treatment, probably focusing on bronchial colonization by [potentially pathogenic microorganisms]."
Therefore, high-resolution computed tomography chest imaging should be considered for patients with COPD who are at higher risk for bronchiectasis, according to the investigators. Severe disease, multiple or severe exacerbations of COPD, and chronic colonization by potentially pathogenic microorganisms can elevate the risk. Further studies are warranted to confirm the results and to clarify the association between bronchiectasis and COPD exacerbations, the authors note.
This study was supported by Praxis Pharmaceutical. The authors have disclosed no relevant financial relationships.
Am J Resp Crit Care Med. Published online February 8, 2013.
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