Dimakou Katerina, Gousiou Anna, Toumbis Michail, Kaponi Maria, Chrysikos Serafeim, Thanos Loukas, Triantafillidou Christina
5th Pulmonary Department, "Sotiria" Chest Diseases Hospital, Athens, Greece.
American College of Greece (Deree), Aghia Paraskevi Campus, Athens, Greece.
Clin Respir J. 2018 Mar;12(3):1212-1218. doi: 10.1111/crj.12653. Epub 2017 Jun 8.
The presence of bronchiectasis in patients with asthma varies in different reports, while a clear aetiological relation has not been precisely established.
To investigate the presence of bronchiectasis in patients with severe uncontrolled asthma and examine whether they contribute to the severity of asthma.
Patients with severe asthma were prospectively recruited. HRCT of the chest was performed to identify and grade bronchiectasis using the 'Smith' radiology scale. Investigation of the underlying cause was carried out for patients with bronchiectasis in order to exclude aetiologies other than asthma. The Statistical Package for the Social Sciences (SPSS), version 21, was used.
Forty patients were studied, 28 women, mean age (±SD) 57.9 years (±12.4). Mean ACT score was 14.2(±4.9). Main symptoms were: wheezing (95%), cough (92%), dysponea (92%) and sputum production (72%). Mean duration of asthma was 16.5(±11.5) years, exacerbations: 4.4(±2.7)/year. In 27 patients (67.5%) bronchiectasis was diagnosed. In nine patients (22.5%) pathogens were cultured in sputum (mainly Pseudomonas aeruginosa, Haemophilus influenzae). Patients with sputum production and pathogens in sputum cultures had a higher Smith score compared to those without expectoration and without pathogens, respectively (P = .005, P < .0001). No correlation was found between the extent of bronchiectasis and lung function. The radiological severity of bronchiectasis was correlated with the antibiotic courses/year (P = .002).
Bronchiectasis is common in patients with severe asthma. Sputum production and pathogen isolation in sputum may indicate the presence of bronchiectasis which seems to contribute to the severity of asthma.
哮喘患者中支气管扩张的存在情况在不同报告中有所不同，而明确的病因关系尚未精确确立。
调查严重未控制哮喘患者中支气管扩张的存在情况，并检查其是否导致哮喘的严重程度。
前瞻性招募严重哮喘患者。进行胸部高分辨率计算机断层扫描（HRCT），使用“史密斯”放射学量表识别支气管扩张并分级。对支气管扩张患者进行潜在病因调查，以排除哮喘以外的病因。使用社会科学统计软件包（SPSS）21版。
研究了40名患者，其中28名女性，平均年龄（±标准差）57.9岁（±12.4）。平均哮喘控制测试（ACT）评分为14.2（±4.9）。主要症状为：喘息（95%）、咳嗽（92%）、呼吸困难（92%）和咳痰（72%）。哮喘平均病程为16.5（±11.5）年，发作次数：4.4（±2.7）次/年。27名患者（67.5%）被诊断为支气管扩张。9名患者（22.5%）痰中培养出病原体（主要为铜绿假单胞菌、流感嗜血杆菌）。与无咳痰和无病原体的患者相比，有咳痰和痰培养出病原体的患者史密斯评分更高（P = 0.005，P < 0.0001）。未发现支气管扩张程度与肺功能之间存在相关性。支气管扩张的放射学严重程度与每年抗生素疗程相关（P = 0.002）。
支气管扩张在严重哮喘患者中很常见。咳痰和痰中病原体分离可能表明存在支气管扩张，这似乎导致哮喘的严重程度增加。
