O7.9 Bronchiectasis

Bronchiectasis is characterised by dilated, thick-walled bronchi that fail to clear airway secretions, leading to a chronic productive cough, persistent bacterial infection and infective exacerbations. In milder COPD patients, bronchiectasis may be an incidental, subclinical finding on CT chest, as observed in the ECLIPSE study where the prevalence of bronchiectasis was 4% (Agusti 2010). In contrast, patients with moderate to severe COPD have a higher prevalence of bronchiectasis of 30 to 60% (O’Brien 2000, Patel 2004, Whitters 2013).

The presence of bronchiectasis influences the rate of respiratory infections and other adverse outcomes in COPD. A meta-analysis of observational studies totalling 5,329 patients with COPD showed that 30% had coexisting bronchiectasis, which increased the risk of exacerbations (OR 2.0), potentially pathogenic microorganisms in sputum (OR 4.1), severe airway obstruction (OR 1.3) and mortality (OR 2.0) (Du 2016).

These studies emphasise the clinical importance of coexisting bronchiectasis in some patients with COPD. A high resolution CT chest scan should be considered in patients with COPD who have chronic bronchitis or frequent respiratory infections, to identify clinically important bronchiectasis which can then be managed in addition to the COPD (Chang 2015, Hurst 2015).