Chen Yen-Fu, Chang Chia-Ling, Hou Hsin-Han, Chien Ning, Lu Kai-Zen, Chen Ying-Yin, Hung Zheng-Ci, Hsiao Yi-Han, Sheu Chau-Chyun, Wang Ping-Huai, Hsieh Meng-Heng, Hsu Wu-Huei, Chen Ming-Tsung, Ou Wei-Fan, Wei Yu-Feng, Yang Tsung-Ming, Lan Chou-Chin, Wang Cheng-Yi, Lin Chih-Bin, Lin Ming-Shian, Wang Yao-Tung, Lin Ching-Hsiung, Liu Shih-Feng, Cheng Meng-Hsuan, Cheng Wen-Chien, Peng Chung-Kan, Chan Ming-Cheng, Chen Ching-Yi, Jao Lun-Yu, Wang Ya-Hui, Chen Chi-Jui, Chen Shih-Pin, Tsai Yi-Hsuan, Cheng Shih-Lung, Lin Horng-Chyuan, Chien Jung-Yien, Wang Hao-Chien, Yu Chong-Jen
Department of Internal Medicine, National Taiwan University Hospital, Yunlin Branch, Douliu, Taiwan.
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
ERJ Open Res. 2025 Mar 10;11(2). doi: 10.1183/23120541.00626-2024. eCollection 2025 Mar.
The radiology, obstruction, symptoms and exposure (ROSE) criteria provide a standardised approach for identifying the "COPD-bronchiectasis (BE) association." However, the clinical implications and outcomes of the COPD-BE association in East Asian populations remain unclear. Our study applied the ROSE criteria to assess the prevalence, clinical impact and outcomes of the COPD-BE association in an East Asian cohort, and compared that cohort with nonsmoking BE patients with fixed airflow obstruction (FAO) and those without FAO.
An integrated cohort analysis was conducted within a Taiwanese demographic, combining a prospective cohort of 147 participants with a multicentre retrospective cohort of 574 participants. Stratification was based on the ROSE criteria, distinguishing between nonsmoking BE, smoking BE, nonsmoking BE with FAO and BE in compliance with the ROSE criteria. Clinical, radiological and spirometric variables were assessed in conjunction with outcomes to validate the diagnostic utility of the criteria.
Using the ROSE criteria, we found that 16.5% of participants had a COPD-BE association (22.4% in the prospective cohort and 14.9% in the retrospective cohort), predominantly in older male patients. These patients had escalated dyspnoea scores, higher COPD diagnosis rates and increased use of inhalation therapies, compared with those without FAO. Notably, patients with a COPD-BE association and nonsmoking BE with FAO displayed similar clinical symptoms, pulmonary function and disease severity, but differed slightly in airway microbiology. Furthermore, patients with a COPD-BE association had significantly higher risks of exacerbations and hospitalisations, even after adjusting for confounding factors, which highlights that they have poorer clinical outcomes than other groups.
The ROSE criteria effectively identify the COPD-BE association in East Asian populations, highlighting a significant future exacerbation risk compared with other BE groups. Future research is warranted to better understand BE progression, especially in FAO subgroups.
放射学、阻塞、症状及暴露（ROSE）标准为识别“慢性阻塞性肺疾病-支气管扩张（COPD-BE）关联”提供了一种标准化方法。然而，COPD-BE关联在东亚人群中的临床意义及预后仍不明确。我们的研究应用ROSE标准评估东亚队列中COPD-BE关联的患病率、临床影响及预后，并将该队列与非吸烟的伴有固定气流受限（FAO）的BE患者以及无FAO的BE患者进行比较。
在台湾人群中进行了一项综合队列分析，将147名参与者的前瞻性队列与574名参与者的多中心回顾性队列相结合。分层基于ROSE标准，区分非吸烟BE、吸烟BE、伴有FAO的非吸烟BE以及符合ROSE标准的BE。结合临床、放射学和肺功能变量及预后情况，以验证该标准的诊断效用。
应用ROSE标准，我们发现16.5%的参与者存在COPD-BE关联（前瞻性队列中为22.4%，回顾性队列中为14.9%），主要为老年男性患者。与无FAO的患者相比，这些患者的呼吸困难评分升高、COPD诊断率更高且吸入治疗的使用增加。值得注意的是，存在COPD-BE关联的患者与伴有FAO的非吸烟BE患者表现出相似的临床症状、肺功能和疾病严重程度，但在气道微生物学方面略有不同。此外，即使在调整混杂因素后，存在COPD-BE关联的患者发生急性加重和住院的风险仍显著更高，这突出表明他们的临床预后比其他组更差。
ROSE标准能有效识别东亚人群中的COPD-BE关联，凸显出与其他BE组相比未来急性加重风险显著更高。有必要开展进一步研究以更好地了解BE的进展情况，尤其是在FAO亚组中。
