Evaluating hemoptysis hospitalizations among patients with bronchiectasis in the United States: a population-based cohort study

Clinically significant hemoptysis and all-cause mortality in patients with nontuberculous mycobacterial pulmonary disease

BACKGROUND

Hemoptysis is one of the major symptoms in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD). However, its prevalence, incidence, and impact on long-term prognosis remain uncertain. We evaluated the incidence of clinically significant hemoptysis, and determined its association with mortality in patients with NTM-PD.

METHODS

Patients enrolled in a prospective observational cohort (NCT01616745) between July 2011 and May 2023 were analyzed. We evaluated risk factors for clinically significant hemoptysis-defined as hemoptysis events requiring interventions such as bronchial artery embolization or surgical resection-and its association with all-cause mortality.

RESULTS

Among 506 patients from the ongoing cohort, 43 patients (8.5 %) experienced clinically significant hemoptysis during a median follow-up of 5.1 years. The overall incidence of clinically significant hemoptysis was 2.1 (95 % confidence interval [CI]; 1.5-2.9) cases per 100 person-years. Identified risk factors included a history of tuberculosis (incidence rate ratio [IRR], 1.91; 95 % CI, 1.02-3.60), higher C-reactive protein (CRP) (IRR, 1.20 for 1 mg/dl increase; 95 % CI, 1.01-1.43), and lower % predicted forced vital capacity (FVC) (IRR, 0.81 for 10 % increase; 95 % CI, 0.66-0.98). Clinically significant hemoptysis was independently associated with an increased risk of all-cause mortality (adjusted hazard ratio, 2.39; 95 % CI, 1.31-4.36).

CONCLUSION

In patients with NTM-PD, those with history of tuberculosis, higher CRP levels, and lower % predicted FVC were at a higher risk of subsequent clinically significant hemoptysis. Importantly, clinically significant hemoptysis was associated with an elevated risk of all-cause mortality.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov; No.: NCT01616745.

Causative diseases of bloody sputum and hemoptysis in respiratory clinics in Japan

BACKGROUND

No previous studies have compared respiratory clinics and respiratory specialized facilities regarding causative diseases for bloody sputum and hemoptysis in Japan.

METHODS

We retrospectively compared causative diseases for bloody sputum and hemoptysis between 3 respiratory clinics (clinic group) and 7 departments of respiratory medicine at hospitals (hospital group) in Japan.

RESULTS

We collected data from 231 patients (median age, 51 years; age range, 24-96 years; 109 men (47.2%)) in the clinic group and 556 patients (median age, 73 years; age range, 21-98 years; 302 men (54.3%)) in the hospital group. In the former group, the main causative disease was acute bronchitis (91 patients, 39.4%), acute upper respiratory tract infection (34 patients, 14.7%), and bronchiectasis (BE) (29 patients, 12.6%). In the latter group, the main causative diseases were BE (102 patients, 18.3%), lung cancer (97 patients, 17.4%), and non-tuberculous mycobacterial disease (NTM) (89 patients, 16%). In particular, in patients ≥60 years old, BE was an important causative disease for bloody sputum and hemoptysis in both groups.

CONCLUSIONS

The present study is the first to compare respiratory clinics and respiratory specialized facilities. Depending on the facility in which the patient is examined, lung cancer, BE, and NTM were identified as diseases requiring special attention as causes of bloody sputum and hemoptysis.

The Economic Burden of Bronchiectasis: A Systematic Review

BACKGROUND

Bronchiectasis, a previously neglected condition, now has renewed research interest. There are a few systematic reviews that have reported on the economic and societal burden of bronchiectasis in adults, but none have reported on children. We undertook this systematic review to estimate the economic burden of bronchiectasis in children and adults.

RESEARCH QUESTION

What is the health care resource utilization and economic burden of bronchiectasis in adults and children?

STUDY DESIGN AND METHODS

We performed a systematic review identifying publications from Embase, PubMed, Web of Science, Cochrane (trials, reviews, and editorials), and EconLit about the economic burden and health care utilization in adults and children with bronchiectasis between January 1, 2001, and October 10, 2022. We used a narrative synthesis approach and estimated aggregate costs for several countries.

RESULTS

We identified 53 publications reporting on the economic burden and/or health care utilization of people with bronchiectasis. Total annual health care costs per adult patient ranged from 2021 $3,579 to $82,545 USD and were predominantly driven by hospitalization costs. Annual indirect costs including lost income because of illness (reported in only five studies) ranged from $1,311 to $2,898 USD. Total health care costs in children with bronchiectasis were $23,687 USD annually in the one study that estimated them. Additionally, one publication found that children with bronchiectasis missed 12 school days per year. We estimated aggregate annual health care costs for nine countries, ranging from $101.6 million per year in Singapore to $14.68 billion per year in the United States. We also estimated the aggregate cost of bronchiectasis in Australian children to be $17.77 million per year.

INTERPRETATION

This review highlights the substantial economic burden of bronchiectasis for patients and health systems. To our knowledge, it is the first systematic review to include the costs for children with bronchiectasis and their families. Future research to examine the economic impact of bronchiectasis in children and economically disadvantaged communities, and to further understand the indirect burden of bronchiectasis on individuals and the community, is needed.

Flexible bronchoscopy indications and outcomes between indigenous and non-indigenous patients in the Northern Territory of Australia

BACKGROUND

There is sparse evidence in the literature in relation to indications and outcomes among adult indigenous patients requiring a flexible bronchoscopy (FB). In this study, FB indications and outcomes between indigenous and non-indigenous patients were assessed.

AIM

To assess the similarities and differences of FB indications and outcomes between indigenous and non-indigenous patients.

METHODS

Self-reported indigenous status, resident locality and the primary indication for FB were assessed. The FB procedures details, results of microbiology, cytology and histopathology were compared between indigenous and non-indigenous patients. Chest computed tomography (CT) was also analysed for its relationship to FB outcomes.

RESULTS

Of the 403 patients, 111 (28%) were indigenous, and indigenous patients were younger (mean difference 11 years) and had a higher proportion of remote residence (70% vs 13%). Malignancy (40%) and infection (31%) were the most common indications for FB, although indigenous patients reported significantly more haemoptysis (15% vs 9%). No differences were noted in findings of the preceding chest CT scans. For positive microbiology, indigenous patients had a higher presence of Streptococcus pneumoniae (30% vs 9%), while non-indigenous patients had a higher presence of Pseudomonas aeruginosa (43% vs 11%) and mycobacteria (15% vs 4%). There was no significant difference between indigenous and non-indigenous patients for a positive histopathology, particularly for a diagnosis of lung malignancy (58% vs 54%).

CONCLUSIONS

This study has demonstrated that adult indigenous patients requiring a FB are significantly younger, tend to reside in remote communities and demonstrate differing microbiology with no significant difference in the diagnostic outcomes for lung malignancy. Ethnic status or remoteness should not preclude indigenous patients to undergo a FB if clinically indicated.

Hemoptysis as the presenting manifestation of bronchiectasis-associated hospitalization in Korea

BACKGROUND

Patients with bronchiectasis commonly experience disease exacerbations, which cause significant morbidity and mortality. However, data regarding the clinical features of bronchiectasis patients hospitalized with hemoptysis are scarce.

METHODS

We retrospectively collected the data of patients with bronchiectasis-associated hospitalization at a tertiary referral center in Korea, and classified them into the hemoptysis and infective exacerbation (IE) groups. The presence of hemoptysis was defined as a volume of expectorated blood larger than 10 mL per 24 hours. The clinical, radiological, and laboratory parameters were compared between the two groups.

RESULTS

Patients were classified into the hemoptysis [267 (54.5%)] and IE [223 (45.5%)] groups. Among the 44 patients of the hemoptysis group, 37 (84.1%) presented with hemoptysis than with IE at the recurrent episode. The hemoptysis group had a significantly lower 30-day mortality than that of the IE group. Previous pulmonary tuberculosis (TB), mycetoma, and bronchial artery hypertrophy were independently associated with the hemoptysis group. In contrast, male sex, poor performance status, colonization of Pseudomonas aeruginosa, ≥3 involved lobes, cystic bronchiectasis, and emphysema were inversely associated with the hemoptysis group. The absence of hemoptysis was one of the independent predictors of 30-day mortality in patients with bronchiectasis-associated hospitalization.

CONCLUSIONS

In Korea, bronchiectasis patients hospitalized with hemoptysis exhibit a distinct phenotype, and are more likely to have previous pulmonary TB, mycetoma, and bronchial artery hypertrophy. Hemoptysis is associated with a lower risk of short-term mortality compared to IE in bronchiectasis-associated hospitalization.

Bronchiectasis as co morbidity with COPD or ILD: complex interactions and severe consequences

Background

Bronchiectasis is a chronic pulmonary disease characterized by widened, malformed bronchi, with profuse expectoration and impaired quality of life. COPD and ILD are common co-morbidities with bronchiectasis.

Methods

The present study evaluated the clinical, laboratory& radiological characteristics of COPD and ILD with/without bronchiectasis. A hospital-based, retrospective study was conducted for 1 year.

Results

A total of 101 patients were analyzed, 60 patients had COPD, 34 had ILD and 7 patients had bronchiectasis without COPD or ILD. It was noticed that, out of the analyzed 60 COPD patients, 10 patients developed bronchiectasis (16.7%) versus10 patients of 34 ILD patients (29.4%). In COPD and ILD accompanied by bronchiectasis, the incidence of hemoptysis was significantly higher in comparison to those without bronchiectasis. Moreover, they showed a significant increase in partial pressure of carbon dioxide (PCO2) in comparison to those without bronchiectasis, as well as in comparison to bronchiectasis only. Sputum culture revealed that COPD with bronchiectasis were significantly associated with Staphlococcus aureus (77.8%), more than ILD with Bronchiectasis (33.3%). While S. pneumoniae were more evident in cases of ILD with bronchiectasis (22.2%). The bilateral, peripheral bronchiectasis was more common than the unilateral, central bronchiectasis among cases of COPD with bronchiectasis followed by ILD with bronchiectasis more than bronchiectasis only.

Conclusion

Patients with COPD /ILD with bronchiectasis can be associated with serious clinical manifestations as hemoptysis. Their sputum cultures detected more positive organisms than negative in comparison to cases of bronchiectasis only. Screening of COPD and ILD patients using HRCT Scanning is a recommended preventive measure for early detection of bronchiectasis.

Pseudomonas aeruginosa isolation is an important predictor for recurrent hemoptysis after bronchial artery embolization in patients with idiopathic bronchiectasis: a multicenter cohort study

BACKGROUND

Nearly half of bronchiectasis patients receiving bronchial artery embolization (BAE) still have recurrent hemoptysis, which may be life-threatening. Worse still, the underlying risk factors of recurrence remain unknown.

METHODS

A retrospective cohort was conducted of patients with idiopathic bronchiectasis who received BAE from 2015 to 2019 at eight centers. Patients were followed up for at least 24 months post BAE. Based on the outcomes of recurrent hemoptysis and recurrent severe hemoptysis, a Cox regression model was used to identify risk factors for recurrence.

RESULTS

A total of 588 individuals were included. The median follow-up period was 34.0 months (interquartile range: 24.3-53.3 months). The 1-month, 1-year, 2-year, and 5-year cumulative recurrent hemoptysis-free rates were 87.2%, 67.5%, 57.6%, and 49.4%, respectively. The following factors were relative to recurrent hemoptysis: 24-h sputum volume (hazard ratio [HR] = 1.99 [95% confidence interval [95% CI]: 1.25-3.15, p = 0.015]), isolation of Pseudomonas aeruginosa (HR = 1.50 [95% CI: 1.13-2.00, p = 0.003]), extensive bronchiectasis (HR = 2.00 [95% CI: 1.29-3.09, p = 0.002]), and aberrant bronchial arteries (AbBAs) (HR = 1.45 [95% CI: 1.09-1.93, p = 0.014]). The area under the receiver operating characteristic curve of the nomogram was 0.728 [95% CI: 0.688-0.769].

CONCLUSIONS

Isolation of Pseudomonas aeruginosa is an important independent predictor of recurrent hemoptysis. The clearance of Pseudomonas aeruginosa might effectively reduce the hemoptysis recurrence rate.

A retrospective analysis of risk factors for massive hemoptysis in patients with bronchiectasis

BACKGROUND

Massive hemoptysis is a common and fatal complication of bronchiectasis. However, the risk factors for massive hemoptysis in patients with bronchiectasis have not yet been reported. This study investigated the potential risk factors for massive hemoptysis in patients with bronchiectasis.

METHODS

This retrospective study included patients with bronchiectasis and their data were obtained from medical records. The risk factors for massive hemoptysis were evaluated by multivariate analysis of patient characteristics, medical history, and computed tomography imaging data, including the number of lesions, lesion location, and laboratory findings.

RESULTS

Among 379 patients, 61 (16.09%) experienced severe hemoptysis. Multivariate analysis revealed that diabetes (odds ratio (OR) 2.885; 95% confidence interval (CI) 1.009-8.247), lesions involving two lobes (OR 4.347; 95% CI 1.960-9.638) and three lobes (OR 2.787; 95% CI 1.055-7.363) were significant predictors of severe hemoptysis. However, a disease course between 1 and 5 years (OR 0.300; 95% CI 0.112-0.801) and involvement of the left lower lobe (OR 0.394; 95% CI 0.196-0.793) were protective factors for the prevention of massive hemoptysis. Lesions in the right upper lobe were more likely to cause massive hemoptysis (OR 1.458) than involvement of other lobes.

CONCLUSIONS

Diabetes and lesions involving two and three lobes, were risk factors for massive hemoptysis in patients with bronchiectasis. Disease duration between 1 and 5 years and involvement of the left lower lobe were protective factors, while lesions in the right upper lobe had a stronger relationship with massive hemoptysis in patients with bronchiectasis.