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Eosinophilic Bronchiectasis: Prevalence, Severity, and Associated Features—A Cohort Study

医学 支气管扩张 内科学 呼出气一氧化氮 恶化 胃肠病学 前瞻性队列研究 嗜酸性 内型 嗜酸性粒细胞 病因学 队列 哮喘 肺功能 病理
作者
Raffaele Campisi,Santi Nolasco,M. Mancuso,Miriam Spinella,Fabio Vignera,Nunzio Crimi,Carlo Vancheri,Claudia Crimi
出处
期刊:Journal of Clinical Medicine [MDPI AG]
卷期号:13 (16): 4932-4932
标识
DOI:10.3390/jcm13164932
摘要

Background: Bronchiectasis (BE) has been traditionally associated with neutrophilic inflammation, but eosinophilic bronchiectasis (EB) has recently emerged. Data about prevalence, clinical features, and disease severity are lacking. This study aimed to assess the EB prevalence, compare EB with non-EB, evaluate the Type-2 (T2) high endotype in BE (T2-high EB) versus non-T2-high EB, and identify EB predictors. Methods: We conducted a prospective study involving 153 BE patients. The data collected included clinical, radiological, and microbiological findings. BE severity was assessed using the bronchiectasis severity index (BSI), FACED and E-FACED scores, and the bronchiectasis etiology and comorbidity index (BACI). EB was defined as a blood eosinophil count (BEC) ≥ 300 cells/μL, and T2-high EB as BEC ≥ 300 cells/μL with fractional exhaled nitric oxide (FeNO) ≥ 25 ppb. Results: Prevalence was 27% for EB and 20% for T2-high EB. EB patients exhibited poorer lung function and more severe radiologic features, with significantly higher severity scores [BSI, FACED, E-FACED, BACI (p < 0.05)], and a higher median exacerbation rate [4 (2–5) in EB vs. 2 (1–4) in non-EB, p = 0.0002], compared with non-EB patients. T2-high EB patients showed higher severity scores [BSI, FACED, E-FACED (p < 0.05)], as well as worse lung function parameters [FEV1%, FVC%, FEF 25–75% (p < 0.05)] compared with non-T2-high EB patients. In our study, patients with EB exhibited notably worsened lung function and higher BE severity scores compared with their non-EB counterparts, with exacerbations playing a major role in these differences. We found statistically significant positive correlations between BEC and disease severity scores, such as BSI, FACED, and mMRC, as well as an inverse relationship with pulmonary function. The likelihood of EB being present was significantly higher in association with mMRC ≥ 1 (OR = 2.53; 95% CI, 1.26–5.64), exacerbations/year ≥ 1 (OR = 1.27; 95% CI, 1.0–1.63), and chronic PA colonization (OR = 3.9; 95% CI, 1.08–15.8). Conclusions: EB is a distinct endotype. Dyspnea, exacerbations, and PA colonization may be predictive of EB, emphasizing the importance of early detection for improved outcomes. BEC could serve as a useful biomarker of disease severity to consider when diagnosing EB.
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