De la Rosa David, Martínez-Garcia Miguel-Angel, Giron Rosa Maria, Vendrell Montserrat, Olveira Casilda, Borderias Luis, Maiz Luis, Torres Antoni, Martinez-Moragon Eva, Rajas Olga, Casas Francisco, Cordovilla Rosa, de Gracia Javier
Department of Pneumology, Hospital Plató, Barcelona, Spain.
Department of Pneumology, Hospital de Requena, Valencia, Spain.
PLoS One. 2017 May 18;12(5):e0177931. doi: 10.1371/journal.pone.0177931. eCollection 2017.
Few studies have evaluated the coexistence of bronchiectasis (BE) and chronic obstructive pulmonary disease (COPD) in series of patients diagnosed primarily with BE. The aim of this study was to analyse the characteristics of patients with BE associated with COPD included in the Spanish Bronchiectasis Historical Registry and compare them to the remaining patients with non-cystic fibrosis BE.
We conducted a multicentre observational study of historical cohorts, analysing the characteristics of 1,790 patients who had been included in the registry between 2002 and 2011. Of these, 158 (8.8%) were registered as BE related to COPD and were compared to the remaining patients with BE of other aetiologies.
Patients with COPD were mostly male, older, had a poorer respiratory function and more frequent exacerbations. There were no differences in the proportion of patients with chronic bronchial colonisation or in the isolated microorganisms. A significantly larger proportion of patients with COPD received treatment with bronchodilators, inhaled steroids and intravenous antibiotics, but there was no difference in the use of long term oral or inhaled antibiotherapy. During a follow-up period of 3.36 years, the overall proportion of deaths was 13.8%. When compared to the remaining aetiologies, patients with BE associated with COPD presented the highest mortality rate. The multivariate analysis showed that the diagnosis of COPD in a patient with BE as a primary diagnosis increased the risk of death by 1.77.
Patients with BE related to COPD have the same microbiological characteristics as patients with BE due to other aetiologies. They receive treatment with long term oral and inhaled antibiotics aimed at controlling chronic bronchial colonisation, even though the current COPD treatment guidelines do not envisage this type of therapy. These patients' mortality is notably higher than that of remaining patients with non-cystic fibrosis BE.
很少有研究在以支气管扩张症（BE）为主诊断的患者系列中评估支气管扩张症与慢性阻塞性肺疾病（COPD）的共存情况。本研究的目的是分析纳入西班牙支气管扩张症历史登记处的合并COPD的BE患者的特征，并将其与其余非囊性纤维化BE患者进行比较。
我们对历史队列进行了一项多中心观察性研究，分析了2002年至2011年期间登记在册的1790例患者的特征。其中，158例（8.8%）登记为与COPD相关的BE，并与其余其他病因的BE患者进行比较。
COPD患者多为男性，年龄较大，呼吸功能较差且病情加重更频繁。慢性支气管定植患者的比例或分离出的微生物方面无差异。COPD患者接受支气管扩张剂、吸入性类固醇和静脉用抗生素治疗的比例明显更高，但长期口服或吸入抗生素治疗的使用上无差异。在3.36年的随访期内，总死亡率为13.8%。与其他病因相比，合并COPD的BE患者死亡率最高。多变量分析显示，以BE作为主要诊断的患者中COPD的诊断使死亡风险增加1.77倍。
与COPD相关的BE患者与其他病因导致的BE患者具有相同的微生物学特征。他们接受旨在控制慢性支气管定植的长期口服和吸入抗生素治疗，尽管当前的COPD治疗指南未设想此类治疗。这些患者的死亡率明显高于其余非囊性纤维化BE患者。
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