Etiology, Clinical, Radiological, and Microbiological Profile of Patients with Non-cystic Fibrosis Bronchiectasis at a Tertiary Care Hospital of Pakistan.

Nadia Sharif,Muhammad Irfan,Sana Sharif,Mirza Saifullah Baig

doi:10.7759/cureus.7208

Abstract

ObjectivesTo identify the etiology of non-cystic fibrosis bronchiectasis (NCFB), to assess the clinical presentation, radiological findings, and microbiological profile of patients presenting with a diagnosis of bronchiectasis in a tertiary care center of Pakistan.MethodsThis was a prospective observational cohort study where patients with a diagnosis of bronchiectasis proven by high-resolution computed tomography (HRCT) were evaluated for etiology, clinical characteristics, microbiology, radiology, spirometric profile, and in-hospital outcomes.ResultsDuring the study period, 196 patients were diagnosed with NCFB. The majority of the patients were men 76.5% (n = 150) and 83.6% (n = 163) of the total patients were younger than 60 years of age. The majority of these patients (58.7%, n = 111) had a duration of symptoms between 5-10 years. The etiology of bronchiectasis was identified in 92.9% of cases. Post-infectious bronchiectasis was the most common cause (67.8%, n = 133), followed by chronic obstructive pulmonary disease (COPD) (9.2%, n = 18), and allergic bronchopulmonary aspergillosis (ABPA) (7.1%, n = 14). Among the post infectious causes, a history of TB was present in 85% (n = 114/133) of patients. Obstructive impairment was the most common spirometric pattern, observed in 68.9% (n = 135) of patients. Pseudomonas aeruginosa was the most commonly isolated organism (36.2%, n = 71). Hemoptysis was the most frequent complication found in 20.9% of patients (n = 41). Out of these 196 patients, 94.4% (n = 185) received medical management and were discharged from the hospital. Respiratory failure was significantly associated with the Pseudomonas group as compared to non-pseudomonas group [(n = 21 (29%) vs n = 18 (14.4%) p = 0.01]. During hospitalization seven patients (3.6%) were died because of respiratory failure.ConclusionsPost TB bronchiectasis was the leading cause of non-cystic fibrosis (CF) bronchiectasis in this cohort, with Pseudomonas was the commonest pathogen isolated from the respiratory specimen, which was significantly associated with respiratory failure. On spirometry, obstructive impairment was found in the majority of patients and hemoptysis was the most frequent complication.

Highlights

Bronchiectasis is a chronic respiratory condition that was first described by Laënnec in 1819 [1]
This was a prospective observational cohort study where patients with a diagnosis of bronchiectasis proven by high-resolution computed tomography (HRCT) were evaluated for etiology, clinical characteristics, microbiology, radiology, spirometric profile, and in-hospital outcomes
196 patients were diagnosed with non-cystic fibrosis bronchiectasis (NCFB)

Summary

Introduction

Bronchiectasis is a chronic respiratory condition that was first described by Laënnec in 1819 [1]. There are various clinical conditions, which can lead to this chronic debilitating condition: post-infectious, allergic bronchopulmonary aspergillosis (ABPA), immunodeficiency syndromes, connective tissue diseases (CTD), cystic fibrosis (CF), chronic respiratory conditions like asthma, chronic obstructive pulmonary disease (COPD), primary ciliary dyskinesia (PCD) and cases with unknown etiology, i.e., idiopathic [4,5]. Since these conditions differ in their management and prognosis, diagnosis of underlying etiology is important. There has been a growing interest in this rather neglected disease since it is the cause of significant morbidity and mortality all over the world [4]

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