Title: Period Prevalence of Bronchiectasis in Moderate and Severe COPD

Authors: Dr Gunaseelan.G, Dr Jayaprakash.B, Dr Roy.N

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i5.66

Abstract

Chronic obstructive pulmonary disease (COPD), a common preventable and treatable disease characterised by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Exacerbations and comorbidities contribute to overall severity in individual patients. Many studies have observed an association between the COPD and bronchiectasis, reporting the presence of bronchiectasis in up to 50% of patients with moderate to severe COPD, this suggests that there may be a causal relationship in which COPD is a risk factor for bronchiectasis.

Aim of the study: To find the prevalence of bronchiectasis in association with severe and moderate COPD admitted in Respiratory medicine department, Trivandrum over a period of 2 years

Secondary Objective: Relating dyspnoea scale (MMRC), FEV1, amount of daily sputum production (<10 ml,10 ml-30ml,>30 ml) to bronchiectasis.

Study design: Hospital based cross sectional study.

Study Period: January 2012-November 2013.

Study Population: Patients admitted to Respiratory medicine department between the study period who are diagnosed as COPD and labelled as severe and moderate COPD according to GOLD guidelines.

Moderate FEV1 50% ≤ FEV1 < 80% predicted. Severe FEV1 <50% Predicted.

Exclusion criteria: Other causes such as patients with old history of tuberculosis.

Patient not fit to undergo HRCT as suggested by radiologist. Patient not willing to participate.

Methodology: Patient diagnosed as severe or moderate COPD who were willing to participate in the study underwent HRCT from our radiodiagnosis department. Also includes a questionnaire regarding exacerbations, smoking index, dyspnoea scale (MMRC), current smoking status, sputum culture if admitted for infective exacerbations. HRCT was read independently by a radiologist and chest physician with control blinding. If both agree then it will be taken into account. We also try to prove an association between various factors studied through questionnaire and bronchiectasis.

Results & Conclusion: The period prevalence of bronchiectasis in patients with moderate and severe COPD was 34.7%.MMRC (grading), FEV1, years of COPD had significant correlation with presence of bronchiectasis in moderate and severe COPD. Right lower lobe was the most common site. Cylindrical bronchiectasis was the most common type.

Keywords: COPD, Bronchiectasis, Prevalence.

References

1.  1.      Gold report 2013 .available at www.goldcopd.org.

2.      Patel IS, Vlahos I,Wilinson TMA. Bronchiectasis, exacerbation indices and inflammation in Chronic obstructive Pulmonary diseases. Am J Respir Crit Care Med.2004:170(4) 400- 07.

3.      O’Brien C O,Guest PJ,Hill SL,Stokley RA .Physiological and radiological characte-rization of patients  diagnosed with chronic obstructive pulmonary diseases in primary care.Thorax 2000;55(8):635-42

4.      Stokley R A. Neutrophils of  COPD .Chest.2002;121 (sppl 5): 151S -155S

5.      Pefia VS,Miravitlles M,Gabriel R. Geographic variations in prevalence and underdiagnosis of COPD:results of the IBERPOC multicentre epidemiological study.Chest.2000;118(4):981-89.

6.      Weycker D,Edelsberg J,Oster G.Tino G.Prevalence and economic burden of Bronchiectasis .Cli Pulm Med.2005; 12(4):205-09

7.      Pasteur MC, Bilton D, Hill AT.. British Thoracic Society guideline for non-CF bronchiectasis. Thorax 2010;65: Suppl. 1, i1–i58.

8.      Martínez-García MÁ1, Soler-Cataluña JJ,  Donat Sanz Y, Catalán Serra P, Agramunt Lerma M, Ballestín Vicente J, Perpiñá-Tordera M. Factors associated with bronchiectasis in patients with COPD. Chest. 2011 Nov;140(5):1130-7.

9.      Kessler R,Partridge MR,Miravitlles M,Cazzola M,Vogelmeier C,Leylnaud D et al.Symptom variability in patients with severe COPD: a pan-Eurpean cross secti-onal study. Eur Respir J 2011;37:264-72.

10.  Hurst JR, Elborn JS, Soyza AD.COPD – Bronchiectasis overlap syndrome.  

11.  Du Q, Jin J, Liu X, Sun Y. Bronchiectasis as a Comorbidity of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Sethi S, ed. PLoS ONE. 2016;11(3):e0150532. doi:10.1371/journal.pone.0150532.

12.  Goeminne PC, Nawrot TS, Ruttens D, et al. Mortality in non-cystic fibrosis bronchiectasis: a prospective cohort analysis. Respir Med 2014; 108: 287–296.

Corresponding Author

Dr Jayaprakash.B

Additional Professor, Dept. of Pulmonary medicine

Govt. Medical College, Trivandrum, Kerala.695011

Tel: 9447658148; Email: This email address is being protected from spambots. You need JavaScript enabled to view it.