The need for a better identification of COPD-bronchiectasis phenotype

Introduction: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality around the world. Underlying structural changes in COPD, such as bronchiectasis, may modulate the severity of the disease and increase morbidity associated with exacerbations. Objectives: To assess the impact of bronchiectasis in COPD exacerbations. Methods: Retrospective observational study of a cohort of patients diagnosed with COPD according to the criteria of Global Initiative for Chronic Obstructive Lung Disease (GOLD). Anthropometric data, current therapy and spirometry data were recorded. High-resolution CT scans of the chest were used to diagnose bronchiectasis. COPD exacerbation was defined for the need of urgent care, hospitalization and/or additional therapy. All exacerbation data concerns the period between January 2015 to December 2016. Results: We included 380 COPD patients, of which 68 (17,9%) had bronchiectasis. No differences were found between groups in terms of age, gender, body mass index, post-bronchodilator FEV1/FVC and FEV1. Bronchiectasis was associated with a statistical significant risk of exacerbations (2,4 ± 2,2 vs 1,0 ± 1,1;p vs 56,6%;p=0,001). Conclusions: The COPD-bronchiectasis phenotype was associated with a statistical significant risk of exacerbations. This group had a higher use of ICS, perhaps due to the high frequency rates of exacerbation. A better identification of this set of patients may have important implications on clinical and therapeutic approaches once these patients may benefit from specific therapies.