The relationship of bronchiectasis to airway obstruction and inflammation in patients with chronic obstructive pulmonary disease

Abstract

BACKGROUND: Chronic obstructive pulmonary disease (COPD) and bronchiectasis are diseasesof respiratory tract with significant mortality and morbidity. These two diseases can be seen togetheroccasionally and are thought to change each other's course by adversely affecting the prognosis.The aim of our study was to identify the signs of bronchiectasis in COPD patients, to investigateits possible effects on disease prognosis, and to evaluate these signs for diagnostic convenience.MATERIALS AND METHODS: This prospective study included a total of stable 60 moderate/severeCOPD patients who were admitted to Yedikule Chest Diseases and Chest Surgery Training and ResearchHospital between January 2015 and February 2016. The patients were divided into two groups according tothe presence of bronchiectasis as confirmed radiologically: 35 patients in the bronchiectasis group and 25patients in the control group. Demographic data of the patients were questioned and systemic inflammationparameters, spirometric measurements, blood gas analysis, and clinical evaluation findings were recorded.RESULTS: Bronchiectasis was detected in 58.3% of COPD patients. Patients in two groups are similarin sociodemographical, spirometrical and clinical parameters (P > 0.05). Laboratory tests showed similarresult in between two groups but carbon dioxide(CO2) values in the blood gas analysis were found to behigher in the bronchiectasis group (P < 0.05). The increase in the number of bronchiectasis segmentswas shown to reduce the FEV1/FVC (P < 0.05). In the overall evaluation, FEV1%, mMRC, FVC% andCRP levels were found to be associated with exacerbations in COPD (P < 0.05). The use of antibioticsincreased as FEV1% and FEV1/FVC levels of patients decreased (P < 0.05). In addition, sputumpolymorphonuclear leukocyte (PMNL) values were correlated with spirometric values and as sputumPMNL values increased, spirometric values were found to decrease (P < 0.05 for FEV1% and FVC%).CONCLUSION: Bronchiectasis is common in COPD patients. In two divided groups, blood gas carbondioxide values, which affect mortality, were shown to be higher in the bronchiectasis group. This isa new addition to literature that bronchiectatic COPD patients are experiencing different respiratoryfailure patterns affecting mortality. Diffuse type bronchiectasis has more effect in spirometric resultsof COPD patients. Also, airway obstruction in COPD is well correlated with elevated sputum PMNLvalues which represent airway inflammation and if this is combined with high clinical suspicion itguides to a cost effective way for guiding radiological investigations for bronchiectasis.