Introduction There is increasing recognition that radiological bronchiectasis is present in many patients with COPD. However, estimated prevalence varies from 4% (Agusti, Respir Res; 2010) to 50% (Patel, AJRCCM; 2004), with the prevalence in the UK general secondary care population unknown. We assessed this in patients from the respiratory clinic at our general hospital.
Methods COPD patients underwent chest CT as part of their clinical assessment. Patients were included if COPD was diagnosed based on spirometry and clinical assessment and excluded if there was clinical bronchiectasis. Scoring was by a simplified system based on Smith (Thorax, 1996) and returned a score of 0 (no bronchiectasis), 1 (0–50% of bronchi involved), or 2 (50–100% of bronchi involved) for each lobe, with a total score of 12 including the lingula; emphysema, interstitial lung disease (ILD), or other pathology was noted. The scans were scored independently by two radiologists blinded to disease severity and the average score used for analysis.
Results 100 COPD patients were included. Patient characteristics are summarised in Table 1.
Bronchiectasis was present in 74% of patients (score ≥2/12) and there was significant inter-observer correlation in the scoring (r=0.60, p<0.0001). Scores were highest in the lower lobes and lowest in the middle lobes (1.56 vs 0.96, p<0.000). Patients with widespread bronchiectasis (score ≥6/12, n=27) had a trend towards reduced bronchodilator reversibility (4% vs 9%, p=0.08) than those with limited bronchiectasis. Other spirometric criteria were similar (FEV1%predicted 61 vs 53 [p=0.11], residual volume% predicted 145 vs130, p=0.28, TLCO%predicted 55 vs 52, p=0.54) and rates of P. seudomonas aeruginosa colonisation (7.4% vs 5.5%, p=0.73). Emphysema was present in 88% and ILD in 11%.
Conclusions In this study, we found a higher prevalence of bronchiectasis than previously reported which may reflect the heterogeneity of COPD patients in a general respiratory clinic. Radiological features of bronchial wall thickening and mild bronchiectasis were commonly seen and when widespread this may result in reduced bronchodilator reversibility; however, the presence of radiological bronchiectasis was not related to disease severity. Further work is needed to delineate the clinical consequences of this and the implications for appropriate bronchodilator therapy.
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