1
|
Karamooz E, Brixey AG, Rydzak CE, Primack SL, Markwardt S, Barker AF. Prevalence of pulmonary artery dilation in non-cystic fibrosis bronchiectasis: a computed tomography analysis from a cohort of the US Bronchiectasis and Nontuberculous Mycobacteria Research Registry. J Thorac Dis 2024; 16:1496-1502. [PMID: 38505050 PMCID: PMC10944741 DOI: 10.21037/jtd-23-1316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/05/2024] [Indexed: 03/21/2024]
Abstract
Although pulmonary artery (PA) dilation is independently associated with significant morbidity and mortality in patients with pulmonary diseases irrespective of diagnosed pulmonary hypertension, its relationship with nontuberculous mycobacteria (NTM) is unknown. The Bronchiectasis and NTM Research Registry is a multicenter registry created to foster research in non-cystic fibrosis (CF) bronchiectasis and NTM lung disease. The majority of patients with non-CF bronchiectasis at Oregon Health & Science University have NTM infections. To determine the prevalence of PA dilation in these patients and its association with supplemental oxygen use, severity of bronchiectasis, tobacco use, and NTM in the sputum culture, we evaluated the chest computed tomography (CT) scans from 321 patients in a cross-sectional analysis. We measured the severity of bronchiectasis by applying modified Reiff criteria and measured the diameters of the PA and aorta (Ao), with PA dilation defined as a PA:Ao ratio >0.9. In our cohort, the mean age was 67.3 years and 83.2% were female. The mean modified Reiff score was 7.1, indicating moderate disease severity. Forty-two patients (13.1%) were found to have PA dilation. PA dilation was positively associated with the use of supplemental oxygen (P<0.001), but there was no association between PA dilation and NTM infection.
Collapse
Affiliation(s)
- Elham Karamooz
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Anupama G. Brixey
- Cardiothoracic Imaging Section, Department of Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Chara E. Rydzak
- Cardiothoracic Imaging Section, Department of Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Steven L. Primack
- Cardiothoracic Imaging Section, Department of Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Sheila Markwardt
- Biostatistics and Design Program, Oregon Health & Science University, Portland, OR, USA
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Alan F. Barker
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
2
|
Karamooz E, Brixey AG, Rydzak CE, Primack SL, Markwardt S, Barker AF. Prevalence of pulmonary artery dilation in non-cystic fibrosis bronchiectasis: A CT analysis from a cohort of the US Bronchiectasis and Nontuberculous Mycobacteria Research Registry. RESEARCH SQUARE 2023:rs.3.rs-2711488. [PMID: 36993456 PMCID: PMC10055630 DOI: 10.21203/rs.3.rs-2711488/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Although pulmonary artery (PA) dilation is independently associated with significant morbidity and mortality in patients with pulmonary diseases irrespective of diagnosed pulmonary hypertension, its relationship to nontuberculous mycobacteria (NTM) is unknown. To determine the prevalence of PA dilation in patients with NTM-predominant non-CF bronchiectasis, we evaluated the chest computed tomography (CT) scans from 321 patient in the United States based Bronchiectasis and NTM Research Registry. The majority of our cohort had NTM infection. We measured the severity of bronchiectasis using modified Reiff criteria and measured the diameters of the PA and aorta (Ao), with PA dilation defined as a PA:Ao ratio > 0.9. Forty-two patients (13%) were found to have PA dilation. PA dilation was positively associated with the use of supplemental oxygen (p < 0.001), but there was no association between PA dilation and NTM infection.
Collapse
Affiliation(s)
- Elham Karamooz
- Oregon Health & Science University Pulmonary & Critical Care
| | - Anupama G Brixey
- Cardiothoracic Imaging Section, Department of Diagnostic Radiology, Oregon Health & Science University
| | - Chara E Rydzak
- Cardiothoracic Imaging Section, Department of Diagnostic Radiology, Oregon Health & Science University
| | - Steven L Primack
- Cardiothoracic Imaging Section, Department of Diagnostic Radiology, Oregon Health & Science University
| | - Sheila Markwardt
- Oregon Health & Science University-Portland State University School of Public Health
| | - Alan F Barker
- Oregon Health & Science University Pulmonary & Critical Care
| |
Collapse
|
3
|
Chen H, Shu T, Wang L, Yang L, Hu C, Du S, Wei H. Pulmonary artery enlargement predicts poor survival in patients with COPD: A meta-analysis. Pulm Circ 2022; 12:e12099. [PMID: 35833098 PMCID: PMC9262316 DOI: 10.1002/pul2.12099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 11/12/2022] Open
Abstract
No previous meta-analysis has evaluated the relationship between pulmonary artery enlargement (PAE) measured by computed tomography (CT) and prognosis for patients with chronic obstructive pulmonary disease (COPD). Recently, several studies have suggested poor survival and reduced exercise capacity in COPD patients with PAE on CT scan, but there were conflicting results. We aimed to assess the prognostic value of PAE-CT in patients with COPD. Relevant studies were identified by searching major databases. Pooled outcomes were determined to assess the prognostic value of PAE-CT in COPD patients. Eighteen studies including 5694 participants were included. PAE indicated higher mortality in COPD patients (odds ratio [OR] = 3.06; 95% confidence interval [95% CI]: 1.76-5.32; p < 0.0001), shorter 6-minute walk distance (mean difference [MD] = -67.53 m; 95% CI: -85.98 to -49.08; p < 0.00001), higher pulmonary artery systolic pressure (MD = 15.65 mmHg; 95% CI: 13.20-18.11; p < 0.00001), longer length of hospital stay (MD = 2.92 days; 95% CI: 0.71-5.12; p = 0.009) and more severe symptom such as dyspnea (COPD Assessment Test MD = 3.14; 95% CI: 2.48-3.81; p < 0.00001). We also conducted a subgroup analysis regarding the lung function and blood gas analysis for a stable period and acute exacerbation of COPD patients. In conclusion, PAE is significantly associated with mortality, lower exercise tolerance, and poor quality of life in patients with COPD. PAE may serve as a novel imaging biomarker for risk stratification in patients with COPD in the future.
Collapse
Affiliation(s)
- Huaqiao Chen
- Department of CardiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Tingting Shu
- Department of CardiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Lu Wang
- Department of CardiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Lingzhi Yang
- Department of CardiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Changchun Hu
- Department of Pulmonary and Critical Care MedicineThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Shanshan Du
- Department of CardiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Huang Wei
- Department of CardiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| |
Collapse
|
4
|
Xu JF, Gao YH, Song YL, Qu JM, Guan WJ. Research advances and clinical management of bronchiectasis: Chinese perspective. ERJ Open Res 2022; 8:00017-2022. [PMID: 35415184 PMCID: PMC8995535 DOI: 10.1183/23120541.00017-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/22/2022] [Indexed: 11/20/2022] Open
Abstract
Bronchiectasis is a debilitating chronic suppurative airway disease that confers a substantial burden globally. Despite the notable prevalence, research on bronchiectasis in mainland China remains in its infancy. Nevertheless, there has been a significant leap in the quantity and quality of research, which has contributed to the ever-improving clinical practice. A nationwide collaborative platform has been established to foster multicentre studies, which will help increase the level of evidence further. Here, we summarise the status quo of clinical management and consider the research priorities for bronchiectasis that have been published previously. We also highlight the efforts of the Chinese medical communities to outline the core tasks that need to be addressed within the next decade.
Collapse
Affiliation(s)
- Jin-Fu Xu
- Dept of Respiratory and Critical Care Medicine, Institute of Respiratory Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
- Co-first authors
| | - Yong-Hua Gao
- Dept of Respiratory and Critical Care Medicine, Institute of Respiratory Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
- Co-first authors
| | - Yuan-Lin Song
- Zhongshan Hospital, Fudan University, Shanghai, China
- Co-first authors
| | - Jie-Ming Qu
- Affiliated Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- These authors contributed equally
- Senior author
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Dept of Thoracic Surgery, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Dept of Respiratory and Critical Care Medicine, Foshan Second People's Hospital, Affiliated Foshan Hospital of Southern Medical University, Foshan, China
- These authors contributed equally
| |
Collapse
|
5
|
Sandelowsky H, Weinreich UM, Aarli BB, Sundh J, Høines K, Stratelis G, Løkke A, Janson C, Jensen C, Larsson K. COPD - do the right thing. BMC FAMILY PRACTICE 2021; 22:244. [PMID: 34895164 PMCID: PMC8666021 DOI: 10.1186/s12875-021-01583-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/09/2021] [Indexed: 12/28/2022]
Abstract
A gap exists between guidelines and real-world clinical practice for the management and treatment of chronic obstructive pulmonary disease (COPD). Although this has narrowed in the last decade, there is room for improvement in detection rates, treatment choices and disease monitoring. In practical terms, primary care practitioners need to become aware of the huge impact of COPD on patients, have non-judgemental views of smoking and of COPD as a chronic disease, use a holistic consultation approach and actively motivate patients to adhere to treatment.This article is based on discussions at a virtual meeting of leading Nordic experts in COPD (the authors) who were developing an educational programme for COPD primary care in the Nordic region. The article aims to describe the diagnosis and lifelong management cycle of COPD, with a strong focus on providing a hands-on, practical approach for medical professionals to optimise patient outcomes in COPD primary care.
Collapse
Affiliation(s)
- Hanna Sandelowsky
- Department of Medicine, Clinical Epidemiology Division T2, Karolinska University Hospital, Karolinska Institutet, Solna, SE-171 76, Stockholm, Sweden.
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
- Academic Primary Healthcare Centre, Stockholm County, Stockholm, Sweden.
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
- The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Bernt B Aarli
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Josefin Sundh
- Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Georgios Stratelis
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
- AstraZeneca Nordic, Södertälje, Sweden
| | - Anders Løkke
- Department of Medicine, Little Belt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | - Kjell Larsson
- Integrative Toxicology, National Institute of Environmental Medicine, IMM, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
6
|
Sedghi Gamechi Z, Arias-Lorza AM, Saghir Z, Bos D, de Bruijne M. Assessment of fully automatic segmentation of pulmonary artery and aorta on noncontrast CT with optimal surface graph cuts. Med Phys 2021; 48:7837-7849. [PMID: 34653274 PMCID: PMC9298252 DOI: 10.1002/mp.15289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 08/24/2021] [Accepted: 09/09/2021] [Indexed: 01/29/2023] Open
Abstract
Purpose Accurate segmentation of the pulmonary arteries and aorta is important due to the association of the diameter and the shape of these vessels with several cardiovascular diseases and with the risk of exacerbations and death in patients with chronic obstructive pulmonary disease. We propose a fully automatic method based on an optimal surface graph‐cut algorithm to quantify the full 3D shape and the diameters of the pulmonary arteries and aorta in noncontrast computed tomography (CT) scans. Methods The proposed algorithm first extracts seed points in the right and left pulmonary arteries, the pulmonary trunk, and the ascending and descending aorta by using multi‐atlas registration. Subsequently, the centerlines of the pulmonary arteries and aorta are extracted by a minimum cost path tracking between the extracted seed points, with a cost based on a combination of lumen intensity similarity and multiscale medialness in three planes. The centerlines are refined by applying the path tracking algorithm to curved multiplanar reformatted scans and are then smoothed and dilated nonuniformly according to the extracted local vessel radius from the medialness filter. The resulting coarse estimates of the vessels are used as initialization for a graph‐cut segmentation. Once the vessels are segmented, the diameters of the pulmonary artery (PA) and the ascending aorta (AA) and the PA:AA ratio are automatically calculated both in a single axial slice and in a 10 mm volume around the automatically extracted PA bifurcation level. The method is evaluated on noncontrast CT scans from the Danish Lung Cancer Screening Trial (DLCST). Segmentation accuracy is determined by comparing with manual annotations on 25 CT scans. Intraclass correlation (ICC) between manual and automatic diameters, both measured in axial slices at the PA bifurcation level, is computed on an additional 200 CT scans. Repeatability of the automated 3D volumetric diameter and PA:AA ratio calculations (perpendicular to the vessel axis) are evaluated on 118 scan–rescan pairs with an average in‐between time of 3 months. Results We obtained a Dice segmentation overlap of 0.94 ± 0.02 for pulmonary arteries and 0.96 ± 0.01 for the aorta, with a mean surface distance of 0.62 ± 0.33 mm and 0.43 ± 0.07 mm, respectively. ICC between manual and automatic in‐slice diameter measures was 0.92 for PA, 0.97 for AA, and 0.90 for the PA:AA ratio, and for automatic diameters in 3D volumes around the PA bifurcation level between scan and rescan was 0.89, 0.95, and 0.86, respectively. Conclusion The proposed automatic segmentation method can reliably extract diameters of the large arteries in non‐ECG‐gated noncontrast CT scans such as are acquired in lung cancer screening.
Collapse
Affiliation(s)
- Zahra Sedghi Gamechi
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Andres M Arias-Lorza
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Zaigham Saghir
- Department of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Daniel Bos
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Marleen de Bruijne
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
7
|
Traversi L, Miravitlles M, Martinez-Garcia MA, Shteinberg M, Bossios A, Dimakou K, Jacob J, Hurst JR, Paggiaro PL, Ferri S, Hillas G, Vogel-Claussen J, Dettmer S, Aliberti S, Chalmers JD, Polverino E. ROSE: radiology, obstruction, symptoms and exposure - a Delphi consensus definition of the association of COPD and bronchiectasis by the EMBARC Airways Working Group. ERJ Open Res 2021; 7:00399-2021. [PMID: 34820447 PMCID: PMC8607072 DOI: 10.1183/23120541.00399-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/05/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The coexistence of COPD and bronchiectasis seems to be common and associated with a worse prognosis than for either disease individually. However, no definition of this association exists to guide researchers and clinicians. METHODS We conducted a Delphi survey involving expert pulmonologists and radiologists from Europe, Turkey and Israel in order to define the "COPD- [bronchiectasis] BE association".A panel of 16 experts from EMBARC selected 35 statements for the survey after reviewing scientific literature. Invited participants, selected on the basis of expertise, geographical and sex distribution, were asked to express agreement on the statements. Consensus was defined as a score of ≥6 points (scale 0 to 9) in ≥70% of answers across two scoring rounds. RESULTS 102 (72.3%) out of 141 invited experts participated in the first round. Their response rate in the second round was 81%. The final consensus definition of "COPD-BE association" was: "The coexistence of (1) specific radiological findings (abnormal bronchial dilatation, airways visible within 1 cm of pleura and/or lack of tapering sign in ≥1 pulmonary segment and in >1 lobe) with (2) an obstructive pattern on spirometry ([forced expiratory volume in 1 s] FEV1/[forced vital capacity] FVC <0.7), (3) at least two characteristic symptoms (cough, expectoration, dyspnoea, fatigue, frequent infections) and (4) current or past exposure to smoke (≥10 pack-years) or other toxic agents (biomass, etc.)". These criteria form the acronym "ROSE" (Radiology, Obstruction, Symptoms, Exposure). CONCLUSIONS The Delphi process formulated a European consensus definition of "COPD-BE association". We hope this definition will have broad applicability across clinical practice and research in the future.
Collapse
Affiliation(s)
- Letizia Traversi
- Dept of Medicine and Surgery, Respiratory Diseases, Università dell'Insubria, Varese-Como, Italy
- Pneumology Dept, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Marc Miravitlles
- Pneumology Dept, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
- CIBER de Enfermedades Respiratorias, Barcelona, Spain
| | - Miguel Angel Martinez-Garcia
- CIBER de Enfermedades Respiratorias, Barcelona, Spain
- Respiratory Dept, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Michal Shteinberg
- Pulmonology Institute and Cystic Fibrosis Center, Carmel Medical Center, and the Technion – Israel Institute of Technology, the B. Rappaport Faculty of Medicine, Haifa, Israel
| | - Apostolos Bossios
- Dept of Respiratory Medicine and Allergy, Karolinska University Hospital and Dept of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Katerina Dimakou
- 5th Respiratory Department, “SOTIRIA” Hospital for Chest diseases, Athens, Greece
| | - Joseph Jacob
- Centre for Medical Image Computing, University College London, London, UK
- UCL Respiratory, University College London, London, UK
| | - John R. Hurst
- UCL Respiratory, University College London, London, UK
| | - Pier Luigi Paggiaro
- Dept of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Sebastian Ferri
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
- Dept of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Georgios Hillas
- 5th Respiratory Department, “SOTIRIA” Hospital for Chest diseases, Athens, Greece
| | - Jens Vogel-Claussen
- Institute of Diagnostic and Interventional Radiology, German Center for Lung Research, Breath, Hannover Medical School, Hannover, Germany
| | - Sabine Dettmer
- Institute of Diagnostic and Interventional Radiology, German Center for Lung Research, Breath, Hannover Medical School, Hannover, Germany
| | - Stefano Aliberti
- Dept of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - James D. Chalmers
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Eva Polverino
- Pneumology Dept, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| |
Collapse
|
8
|
Saad AB, Migaou A, Mhamed SC, Fahem N, Rouatbi N, Joobeur S. [Bronchial dilatations in patients with chronic obstructive pulmonary disease in a Tunisian center: effect on disease progression and prognosis]. Pan Afr Med J 2020; 37:200. [PMID: 33505569 PMCID: PMC7813652 DOI: 10.11604/pamj.2020.37.200.24448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/12/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION bronchial dilations (BDs) seem to have a major role in the natural history of chronic obstructive pulmonary disease (COPD). The purpose of our study was to evaluate the impact of BDs on the severity and progression of COPD as well as on patients' prognosis. METHODS we conducted a retrospective, single-center, analytical study over the period 1995- 2017. The study was based on data from the medical records of patients with COPD who had undergone chest CT scan during the follow-up period. We compared two groups (G) of patients: G1: COPD with BDs; G2: COPD without BDs. RESULTS our study included 466 patients with COPD. Among them 101 (21.6%) had BDs associated with COPD. G1 patients had lower maximum expiratory volume in the first second (FEV1) (G1: 1.21 L, G2: 1.37 L, p = 0.015), lower forced vital capacity (FVC) (p = 0.014), a lower PaO2 at steady state (p = 0.049), a higher rate of acute exacerbations (AE) per year (G1: 3.31, G2: 2.44, p = 0.001) and a higher rate of hospitalizations in the Intensive Care Unit per year (p = 0.02). G1 patients with AE receiving treatment in hospital had lower PaO2 3) on admission (G1: 60 mmHg, G2: 63.7 mmHg, p = 0.02 G2: 63.7 mmHg, p = 0.023), more elevated carbon dioxide (CO2) levels (p = 0.001) and were characterized by a higher use of non-invasive ventilation (NIV) (p = 0.044) and invasive mechanical ventilation (p = 0.011). G2 patients had better overall survival (p = 0.002). CONCLUSION bronchial dilatations are an indicator of poor prognosis in patients with chronic obstructive pulmonary disease, expecially because of the higher rate and severity of exacerbations, airway obstructions and mortality.
Collapse
Affiliation(s)
- Ahmed Ben Saad
- Service de Pneumologie et d´Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, 5000 Monastir, Monastir, Tunisie
| | - Asma Migaou
- Service de Pneumologie et d´Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, 5000 Monastir, Monastir, Tunisie
| | - Saousen Cheikh Mhamed
- Service de Pneumologie et d´Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, 5000 Monastir, Monastir, Tunisie
| | - Nesrine Fahem
- Service de Pneumologie et d´Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, 5000 Monastir, Monastir, Tunisie
| | - Naceur Rouatbi
- Service de Pneumologie et d´Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, 5000 Monastir, Monastir, Tunisie
| | - Samah Joobeur
- Service de Pneumologie et d´Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, 5000 Monastir, Monastir, Tunisie
| |
Collapse
|
9
|
Polverino E, Dimakou K, Hurst J, Martinez-Garcia MA, Miravitlles M, Paggiaro P, Shteinberg M, Aliberti S, Chalmers JD. The overlap between bronchiectasis and chronic airway diseases: state of the art and future directions. Eur Respir J 2018; 52:13993003.00328-2018. [PMID: 30049739 DOI: 10.1183/13993003.00328-2018] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/10/2018] [Indexed: 11/05/2022]
Abstract
Bronchiectasis is a clinical and radiological diagnosis associated with cough, sputum production and recurrent respiratory infections. The clinical presentation inevitably overlaps with other respiratory disorders such as asthma and chronic obstructive pulmonary disease (COPD). In addition, 4-72% of patients with severe COPD are found to have radiological bronchiectasis on computed tomography, with similar frequencies (20-30%) now being reported in cohorts with severe or uncontrolled asthma. Co-diagnosis of bronchiectasis with another airway disease is associated with increased lung inflammation, frequent exacerbations, worse lung function and higher mortality. In addition, many patients with all three disorders have chronic rhinosinusitis and upper airway disease, resulting in a complex "mixed airway" phenotype.The management of asthma, bronchiectasis, COPD and upper airway diseases has traditionally been outlined in separate guidelines for each individual disorder. Recognition that the majority of patients have one or more overlapping pathologies requires that we re-evaluate how we treat airway disease. The concept of treatable traits promotes a holistic, pathophysiology-based approach to treatment rather than a syndromic approach and may be more appropriate for patients with overlapping features.Here, we review the current clinical definition, diagnosis, management and future directions for the overlap between bronchiectasis and other airway diseases.
Collapse
Affiliation(s)
- Eva Polverino
- Pneumology Dept, Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain.,Institut de Recerca Vall d'Hebron (VHIR), Barcelona, Spain.,CIBER, Spain
| | | | - John Hurst
- UCL Respiratory, University College London, London, UK
| | | | - Marc Miravitlles
- Pneumology Dept, Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain.,Institut de Recerca Vall d'Hebron (VHIR), Barcelona, Spain.,CIBER, Spain
| | - Pierluigi Paggiaro
- Dept of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Michal Shteinberg
- Pulmonology Institute and Cystic Fibrosis Center, Carmel Medical Center, Haifa, Israel.,Technion-Israel Institute of Technology, The B. Rappaport Faculty of Medicine, Haifa, Israel
| | - Stefano Aliberti
- Dept of Pathophysiology and Transplantation, University of Milan Internal Medicine Dept, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| |
Collapse
|