Factors Associated With Bronchiectasis In Patients With COPD

Chronic obstructive pulmonary disease(COPD) and bronchiectasis are two different diseases. On the high resolution of pulmonary CT, we found that both of them could occur separetely, but could coexist in one patient. In 2014, Global Initiative for Chronic Obstructive Lung Disease(GOLD)defines coexisting, COPD and bronchiectasis as an unique phenotypes that is prone to the poor prognosis of chronic infection with pathogenic microorganisms, potential or constant value, associated with frequent acute exacerbation. The research combined with acute exacerbation of chronic obstructive pulmonary disease multi center(AECOPD) analysis of hospitalized patients, lists some clinical features of patients with coexisting chronic obstructive pulmonary disease and bronchiectasis.Objective:The aims of this study were to evaluate the incidence of bronchiectasis on high resolution computed tomography(HRCT) scanning in patients with moderate and severe COPD, and tobuild the relationship between the coexists with the presence of lower airway bacterial colonization, exacerbation frequency, severity.Method:During January 2014 to January 2015,we diagnosed 200 patients with AECOPD in The second hospital of Hebei Medical University and Handan Central Hospital,who did not incorporate liver,kidney,digestive tract diseases and tuberculosis,cancer,hyperthyroidism etc.Patients with a prior diagnosis of bronchiectasis were excluded from the study, as were those whose deteriorated basal condition prevented them from undergoing an HRCT scan(as reported by a radiologist)and lung function test.they were based on moderate:FEVl/FVC<70%,50%≤FEV1<80% expected value,with or without chronic cough and expectoration symptoms.severe : FEVl /FVC<70%,30%≤FEVl<50%expectedvalue,with or without chronic cough and expectoration symptoms.Data were collected from all the subjects during a medical visit marking their admission into the study using protocolized medical history questionnaires,both general and pulmonary.This information included general data(age and sex),smoking habits(pack-years),clinical profile(presence and frequency of chronic expectoration and Medical Research Council scale for dyspnea),semiquantitative evaluation of the daily quantity of sputum produced,and ongoing treatment.All cases were subjected to through history taking,lung function test,sputum culture,HRCT scan of the chest to diagnose bronchiectasis.Lung function test and HRCT were performed in a stable phase.We selected six levels in patients with HRCT:the level of lung apex,the tracheal carina and above the right diaphragm of each two level image.These images are performed with<2 mm collimation at end expiration following a forced vital.Results : 200 Patients with moderate to severe COPD were analyzed,82 patients were found to have moderate COPD(41%),mean age 67.48-year old;86.59% men,118 patients(59%) had severe COPD,mean age 69.54- year old; of the cases86.44 % men.86patients had COPD with bronchiectasis and114 patients had COPD without bronchiectasis.Among these 86patients(43%in total) with coexisting COPD and bronchiectasis,27.27% patients showed moderate COPD,while72.73%patients showed severe COPD.It was statistically significant difference.The more severe functional impairment(FEV1 ≤50%) was the greater prevalence of brochiectasis would be. The COPD patients with bronchiectasis exhibited more severe symptoms,particularly chronic expectoration( cough yellow sputum or yellow white phlegm) patients accounted for 73.26%,within one year of acute exacerbation of patients were admitted at least once accounted for 86.05%,severe obstructive ventilatory disorder accounted for 72.73%,the potentially pathogenic microorganisms(PPMs) positive culture patients accounted for 39.53%.The extent of lower lobe bronchiectasis was also related tothe presence of lower airway bacterial colonization which present in 33% of cases;42.63% in severe COPD and 24.82% in moderate COPD.86patients had COPD with bronchiectasis.Positive sputum culture present in 39.53%,27.91%Pseudomonas aeruginosa,114 patients had COPD without bronchiectasis.Positive sputum culture present in 24.56%,7.02%Pseudomonas aeruginosa.In this study,the prevalence of bronchiectasis in patients with moderate to severe COPD in was 43%.Cylindrical bronchiectasis accounted for 72.09%.Bronchiectasis accounted for 67.44% in the lower lobe distribution.Conclusion:1 There is high prevalence of bronchiectasis on high resolutioncomputed tomography(HRCT)scanning in patients with moderate and severe COPD.2 The finding of bronchiectasis on HRCT scan in the patient with COPD may indicate the presence of more advanced airway dysfunction,frequent exacerbation and bacterial colonization.3 Patients with coexisting COPD and bronchiectasis could represent a unique phenotype with more severe disease,worse outcomes.4 the results of this study will be useful for estimating the probability of future bronchiectasis on HRCT scan in the patient with COPD and help guide early appropriate treatment, shortened the course of the disease, the prevention of disease,improve the prognosis of recurrent purpose.