Is it feasible to radiologically monitor the evolution of non-CF bronchiectasis? - Reply.

Abstract

From the Authors: We thank Crivelli et al. for their interest in our article. Previous studies have used a variety of computed tomography (CT) scores in patients with non-cystic bronchiectasis, but these studies did not use large populations nor follow-up their patients for a particularly long time.1, 2 We agree that further studies are needed to validate the Bhalla score in non-cystic fibrosis (CF) patients. In our study, about one-third of the study population showed radiological deterioration of bronchiectasis with the Bhalla score system.3 Although an overall change of the Bhalla score from 9.5 to 10.1 points might not be considered significant by some, the increase in the score in the radiological deterioration group might have radiological importance. In the radiological deterioration group (36.1%), the Bhalla score increased significantly from 9.8 to 11.5 points (P < 0.001). It would be of great interest to examine the differences between the three subgroups ‘improved’, ‘stable’ and ‘progressed’ with regard to the Bhalla score. The determinant parameters of Bhalla score include radiological features that could be affected by clinical circumstance (e.g. the extent of mucus plugging or collapse/consolidation).4 If patients underwent initial chest CT during the acute exacerbation period, the Bhalla score could be decreased in a follow-up chest CT scan. The 12 patients (7.7%) with a decrease in the Bhalla score showed radiological improvement in peribronchial thickening (one patient), grade of extent of mucous plugging (four patients), grade of sacculation or abscess (two patients) and collapse/consolidation (six patients) (one patient improved in both the grade of extent of mucous plugging and collapse/consolidation). Of note was that 10 patients underwent the initial chest CT during the time of acute exacerbation. The Bhalla score has been used widely and this scoring system can be used in research as patient enrolment criteria, to help provide prognostic information, or in communications between physicians. However, the Bhalla score is complex and quite difficult to use. We agree that stratifying longitudinal CT changes might have greater utility in the clinical setting. Further large studies are needed to compare the Bhalla score system with the CT changes.