Abstract
With the increasing use of computed tomography, bronchiectasis has become a common finding in patients with chronic obstructive pulmonary disease (COPD). However, the clinical aspects and medical utilization of COPD with bronchiectasis (BE) remain unclear. We aimed to investigate the BE effect on prognosis and medical utilization in patients with COPD. Among 263,747 COPD patients, we excluded patients lacking chest X-ray, CT, or pulmonary function test codes and classified 2583 GOLD-C/D patients matched according to age, sex, and medical aid as having COPD-BE (447 [17.3%]) and COPD without BE (2136 [82.7%]). Patients with COPD-BE showed a higher rate of acute exacerbation requiring antibiotics than those without BE. Moreover, multivariable analysis showed that BE co-existence was a crucial factor for moderate-to-severe exacerbation (incidence rate ratio [IRR] 1.071; 95% CI 1.012–1.134; p = 0.019). Patients with COPD-BE had a significantly higher rate of exacerbations requiring antibiotics, as well as treatment cost and duration (meant as number of days using hospitalization plus outpatient appointment), than those with COPD without BE (52.64 ± 65.29 vs. 40.19 ± 50.02 days, p < 0.001; 5984.08 ± 8316.96 vs. 4453.40 ± 7291.03 USD, p < 0.001). Compared with patients with COPD without BE, patients with COPD-BE experienced more exacerbations requiring antibiotics, more hospitalizations, and a higher medical cost.
Highlights
Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation and is comprised of a complex disease group with varying effects and pathophysiologies
447 patients with chronic obstructive pulmonary disease (COPD)-BE underwent 1:5 PS matching according to age, sex, and medical aid while 2136 patients with COPD without BE were matched (Fig. 1)
This study investigated the effect of comorbid BE on clinical outcomes and medical utilization in patients with COPD
Summary
Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation and is comprised of a complex disease group with varying effects and pathophysiologies. A study on the Canadian Cohort of Obstructive Lung Disease (CanCOLD) reported that the BE prevalence in patients with mild-to-moderate and severe COPD was 14.1–22.2% and 35.1%, r espectively[12]. In the CanCOLD cohort, COPD-BE was not associated with an increased risk of acute exacerbation; it was associated with dyspnoea and other respiratory symptoms. Other small-scale studies on COPD-BE have reported a wide prevalence range and varying characteristics with respect to exacerbation episodes and respiratory symptoms[4,12,13]. There is a need for a nationwide large-scale study to elucidate the clinical aspects, prognosis, and medical utilization in patients with COPD-BE. This nation-wide representative study aimed to investigate BE-associated outcomes and medical utilization in patients with COPD
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