Background In tertiary care, bronchiectasis (BE) patients are a highly selected group, often with a complex aetiology or associated disease. The national British Thoracic Society bronchiectasis audit provided us with an opportunity to characterise our secondary care bronchiectasis population. We hypothesised that the majority of bronchiectasis seen in our non-specialist service would be associated with chronic obstructive pulmonary disease (COPD). We therefore determined the prevalence of COPD/BE and compared investigation and management of COPD/BE patients to those with bronchiectasis alone.
Methods Patients with a clinical diagnosis of bronchiectasis were identified in respiratory outpatients between 1st October and 30th November 2011 during the national bronchiectasis audit period. Those with bronchiectasis confirmed on CT thorax were included. Data including aetiology, lung function and other investigations were retrieved from electronic records.
Results Forty seven patients were identified, age 65±17 years (range 19 to 88 years), 57% female. Forty percent (19) had COPD Other common aetiologies were post-infection (26%), asthma (21%) and idiopathic (11%). The table compares characteristics between bronchiectasis patients with and without COPD. COPD/BE patients were older and had a significantly greater pack year smoking history. Similar investigations were performed in the two groups. COPD/BE patients had significantly worse airflow obstruction and gas transfer than bronchiectasis patients without COPD COPD/BE patients were more likely to have Pseudomonas aeruginosa, Methicillin Resistant Staphylococcus aureus or coliforms cultured from sputum, but antibiotic treatment and prophylaxis was similar in the two groups. Other medications were similar in the two groups, although COPD/BE patients were more likely than those without COPD to be prescribed long acting anti-cholinergic medication.
Conclusion In our secondary care setting, COPD is the most common underlying condition associated with bronchiectasis. COPD/BE patients share many clinical characteristics with other bronchiectasis patients and have worse lung function and more pathogenic microorganisms isolated from sputum culture. The emerging association between COPD and bronchiectasis requires further research to improve the characterisation and management of this patient group.