Anthony De Soyza1, Melissa J McDonnell2, Pieter C Goeminne3, Stefano Aliberti4, Sara Lonni5, John Davison6, Lieven J Dupont3, Thomas C Fardon7, Robert M Rutherford8, Adam T Hill9, James D Chalmers7. 1. Adult Bronchiectasis Service & Sir William Leech Centre for Lung Research, Freeman Hospital, Heaton, Newcastle, UK; Institute of Cellular Medicine, Newcastle University, Newcastle, UK. Electronic address: anthony.de-soyza@ncl.ac.uk. 2. Institute of Cellular Medicine, Newcastle University, Newcastle, UK; Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland. 3. University Hospital Gasthuisberg, Respiratory Medicine, Leuven, Belgium. 4. Department of Pathophysiology and Transplantation, University of Milan Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 5. Department of Health Science, University of Milan Bicocca, Clinica Pneumologica, Monza, Italy. 6. Adult Bronchiectasis Service & Sir William Leech Centre for Lung Research, Freeman Hospital, Heaton, Newcastle, UK. 7. Tayside Respiratory Research Group, University of Dundee, Dundee, UK. 8. Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland. 9. Department of Respiratory Medicine, Royal Infirmary of Edinburgh and the University of Edinburgh, Edinburgh, UK.
Abstract
BACKGROUND: This study assessed if bronchiectasis (BR) and rheumatoid arthritis (RA), when manifesting as an overlap syndrome (BROS), were associated with worse outcomes than other BR etiologies applying the Bronchiectasis Severity Index (BSI). METHODS: Data were collected from the BSI databases of 1,716 adult patients with BR across six centers: Edinburgh, United Kingdom (608 patients); Dundee, United Kingdom (n = 286); Leuven, Belgium (n = 253); Monza, Italy (n = 201); Galway, Ireland (n = 242); and Newcastle, United Kingdom (n = 126). Patients were categorized as having BROS (those with RA and BR without interstitial lung disease), idiopathic BR, bronchiectasis-COPD overlap syndrome (BCOS), and "other" BR etiologies. Mortality rates, hospitalization, and exacerbation frequency were recorded. RESULTS: A total of 147 patients with BROS (8.5% of the cohort) were identified. There was a statistically significant relationship between BROS and mortality, although this relationship was not associated with higher rates of BR exacerbations or BR-related hospitalizations. The mortality rate over a mean of 48 months was 9.3% for idiopathic BR, 8.6% in patients with other causes of BR, 18% for RA, and 28.5% for BCOS. Mortality was statistically higher in patients with BROS and BCOS compared with those with all other etiologies. The BSI scores were statistically but not clinically significantly higher in those with BROS compared with those with idiopathic BR (BSI mean, 7.7 vs 7.1, respectively; P < .05). Patients with BCOS had significantly higher BSI scores (mean, 10.4), Pseudomonas aeruginosa colonization rates (24%), and previous hospitalization rates (58%). CONCLUSIONS: Both the BROS and BCOS groups have an excess of mortality. The mechanisms for this finding may be complex, but these data emphasize that these subgroups require additional study to understand this excess mortality.
BACKGROUND: This study assessed if bronchiectasis (BR) and rheumatoid arthritis (RA), when manifesting as an overlap syndrome (BROS), were associated with worse outcomes than other BR etiologies applying the Bronchiectasis Severity Index (BSI). METHODS: Data were collected from the BSI databases of 1,716 adult patients with BR across six centers: Edinburgh, United Kingdom (608 patients); Dundee, United Kingdom (n = 286); Leuven, Belgium (n = 253); Monza, Italy (n = 201); Galway, Ireland (n = 242); and Newcastle, United Kingdom (n = 126). Patients were categorized as having BROS (those with RA and BR without interstitial lung disease), idiopathic BR, bronchiectasis-COPD overlap syndrome (BCOS), and "other" BR etiologies. Mortality rates, hospitalization, and exacerbation frequency were recorded. RESULTS: A total of 147 patients with BROS (8.5% of the cohort) were identified. There was a statistically significant relationship between BROS and mortality, although this relationship was not associated with higher rates of BR exacerbations or BR-related hospitalizations. The mortality rate over a mean of 48 months was 9.3% for idiopathic BR, 8.6% in patients with other causes of BR, 18% for RA, and 28.5% for BCOS. Mortality was statistically higher in patients with BROS and BCOS compared with those with all other etiologies. The BSI scores were statistically but not clinically significantly higher in those with BROS compared with those with idiopathic BR (BSI mean, 7.7 vs 7.1, respectively; P < .05). Patients with BCOS had significantly higher BSI scores (mean, 10.4), Pseudomonas aeruginosa colonization rates (24%), and previous hospitalization rates (58%). CONCLUSIONS: Both the BROS and BCOS groups have an excess of mortality. The mechanisms for this finding may be complex, but these data emphasize that these subgroups require additional study to understand this excess mortality.
Authors: H Maura Friedlander; Julia A Ford; Alessandra Zaccardelli; Alexsandra V Terrio; Michael H Cho; Jeffrey A Sparks Journal: Expert Rev Clin Immunol Date: 2020-01-06 Impact factor: 4.473
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Authors: James D Chalmers; Megan Crichton; Pieter C Goeminne; Michael R Loebinger; Charles Haworth; Marta Almagro; Montse Vendrell; Anthony De Soyza; Raja Dhar; Lucy Morgan; Francesco Blasi; Stefano Aliberti; Jeanette Boyd; Eva Polverino Journal: Breathe (Sheff) Date: 2017-09
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