Introduction and objectives Bronchiectasis can contribute to severe and difficult to control asthma. It is important to recognise bronchiectasis in asthmatics and treat them accordingly. In order to estimate the presence of bronchiectasis in severe asthma, and the relation with the clinical and functional parameters we studied 40 patients with severe uncontrolled asthma, in a stable condition.
Methods The symptoms, the duration of asthma diagnosis, the number of exacerbations/year, cycles of corticosteroids and antibiotic treatment/year, spirometry, and bronchial colonisation were estimated. High resolution computed tomography (HRCT) was performed to evaluate the presence and extent of bronchiectasis. HRCT were studied by an expert thoracic radiologist, according to Smith scale for bronchiectasis (score 0–24), taking a score≥3 as radiologically significant.
Results Forty patients were studied, 28 women, mean age (±SD) 57.9 years (±12.4), 32 non smokers. Mean ACT score was 14.2(±4.9).
The main symptoms were: cough (92%), wheezing (95%), dyspnea (92%), sputum production (72%) of which mucoid (52%), mucopurulent and purulent (48%). Mean duration of asthma diagnosis was 16.5(±11.5) years, exacerbations: 4.4(±2.7)/year, corticosteroid per os cycles/year: 4.4 (±3.1), antibiotic cycles/year: 2.8(±2.2).
In 27 patients (67,5%) bronchiectasis was diagnosed: Smith score: 5.2(±4.2).
The mean FEV1 was 72.6% (±21.1) of predicted, FVC 79.1% (±19.4), FEV1/FVC ratio 67.3 (±9.7). Nine patients (22.5%) were colonised with pathogens, 6 of whom with Pseudomonas Aeruginosa. Patients with sputum production had a higher Smith score compared to those without expectoration (6.3 ± 4.2 vs 2.3 ± 2.2 respectively Z = 2.8, p = 0.005). In addition, patients with pathogens in sputum cultures had a higher Smith score compared to those with normal flora (10 ± 4.2 vs 3.8 ± 3 respectively, Z = 3.5, p < 0.0001) (Figure 1).
No correlation was found between the extent of bronchiectasis and the lung function parameters. The severity of bronchiectasis (Smith score) was correlated to the number of antibiotic cycles/year (p = 0.002, r = 0.48). In addition, a lower ACT score was related with a higher asthma exacerbation rate (r = -0.52, p = 0.001).
Conclusion The evidence of bronchiectasis on HRCT is common in patients with severe uncontrolled asthma. Sputum production and pathogen isolation in sputum culture may indicate the presence of this comorbidity and the need of antibiotics as an additional treatment.
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