The Association between Bronchiectasis and Chronic Obstructive Pulmonary Disease: Data from the European Bronchiectasis Registry (EMBARC)
Eva Polverino, Anthony De Soyza, Katerina Dimakou, Letizia Traversi, Apostolos Bossios, Megan Crichton, Felix C. Ringshausen, Montserrat Vendrell, Pierre‐Régis Burgel, Charles Haworth, Michael R. Loebinger, Natalie Lorent, Isabell Pink, Melissa J. McDonnell, Sabina Škrgat, Luis M. Carro, Oriol Sibila, Menno M. vd Eerden, Paula Kauppi, Amelia Shoemark, Adelina Amorim, Jeremy Brown, John R. Hurst, Marc Miravitlles, Rosario Menéndez, Antoní Torres, Tobias Welte, Francesco Blasi, Josje Altenburg, Michal Shteinberg, Wim Boersma, J.S. Elborn, Pieter Goeminne, Stefano Aliberti, James D. Chalmers
Abstract
Abstract Rationale COPD and bronchiectasis are commonly reported together. Studies report varying impacts of co-diagnosis on outcomes, which may be related to different definitions of disease used across studies. Objectives To investigate the prevalence of chronic obstructive pulmonary disease (COPD) associated with bronchiectasis and its relationship with clinical outcomes. We further investigated the impact of implementing the standardized ROSE criteria (radiological bronchiectasis [R], obstruction [FEV1/FVC ratio <0.7; O], symptoms [S], and exposure [⩾10 pack-years of smoking; E]), an objective definition of the association of bronchiectasis with COPD. Methods Analysis of the EMBARC (European Bronchiectasis Registry), a prospective observational study of patients with computed tomography–confirmed bronchiectasis from 28 countries. The ROSE criteria were used to objectively define the association of bronchiectasis with COPD. Key outcomes during a maximum of 5 years of follow-up were exacerbations, hospitalization, and mortality. Measurements and Main Results A total of 16,730 patients with bronchiectasis were included; 4,336 had a clinician-assigned codiagnosis of COPD, and these patients had more exacerbations, worse quality of life, and higher severity scores. We observed marked overdiagnosis of COPD: 22.2% of patients with a diagnosis of COPD did not have airflow obstruction and 31.9% did not have a history of ⩾10 pack-years of smoking. Therefore, 2,157 patients (55.4%) met the ROSE criteria for COPD. Compared with patients without COPD, patients who met the ROSE criteria had increased risks of exacerbations and exacerbations resulting in hospitalization during follow-up (incidence rate ratio, 1.25; 95% confidence interval, 1.15–1.35; vs. incidence rate ratio, 1.69; 95% confidence interval, 1.51–1.90, respectively). Conclusions The label of COPD is often applied to patients with bronchiectasis who do not have objective evidence of airflow obstruction or a smoking history. Patients with a clinical label of COPD have worse clinical outcomes.