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Bronchiectasis increases the risk of clinical deterioration in asthmatic patients

Published: June 8, 2022

Bronchiectasis is a chronic inflammatory lung disease with permanent damage to the lower respiratory tract by irreversible airway dilation. It is a common comorbidity in patients with asthma and the prevalence of bronchiectasis is much higher in severe asthma. Although bronchiectasis is expected to worsen the clinical and functional outcomes in patients with asthma, limited data are available regarding the long-term effects of bronchiectasis on the clinical course of asthma.

In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Kim and their colleagues aimed to evaluated longitudinal clinical outcomes according to bronchiectasis status in patients with asthma from data of a retrospective cohort of patients with asthma who underwent chest computed tomography and pulmonary function tests at two tertiary hospitals. The authors examined acute clinical deterioration and longitudinal lung function changes according to bronchiectasis in asthma patients.

Of 667 patients with asthma, 251 (37.6%) had bronchiectasis. Patients with bronchiectasis had significantly more frequent history of tuberculosis and nontuberculous mycobacterial lung disease, and lower forced expiratory volume in 1 second and forced vital capacity, compared with patients without bronchiectasis. Concomitant bronchiectasis in patients with asthma was significantly associated with higher annual rates of moderate-to-severe episodes of clinical deterioration requiring acute treatment compared with patients with asthma and no bronchiectasis.

In patients with asthma and bronchiectasis, the proportion of patients who experienced clinical deterioration during the follow-up period of approximately 4 years was 10% higher (49.8% vs 39.4%), and risk of moderate-to-severe clinical deterioration was 1.50 times greater compared with patients without bronchiectasis. Notably, progression of bronchiectasis was an independent risk factor for developing moderate-to-severe acute clinical deteriorations during the follow-up period. This study suggests that clinicians treating patients with asthma need to investigate the coexistence and severity of bronchiectasis in those with frequent clinical deteriorations.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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