Bronchiectasis: understanding the phenotype

Introduction: Bronchiectasis (BE) is a chronic disease associated with high morbidity e mortality. Several studies have enlightened pathophysiology, microbiology and epidemiology of the disease, but few is known about its phenotypes. We aimed study clinical BE phenotypes in relation to comorbidities (i.e. COPD and asthma.) Methods: We consecutively enrolled all adult patients with a CT diagnosis of non-cystic fibrosis BE presenting to our Outpatients Clinic in a 6-months period. Patients with traction BE were excluded. All included patients underwent to clinical and laboratory workup, lung function tests and microbiological analysis of sputum. Results: 31 patients (13 males; 4 current smokers) were enrolled into the study. BE were cystic in 29% and cylindric in 71% of patients. In 12 patients BE were extended in 6 lobes, in 16 patients in 3 or 4 lobes and only 3 patients had BE in <2 lobes. Radiologically, patients were defined as severe, moderate or mild respectively in 8, 9 and 14 cases. Comorbidities were: 11 patients with asthma, 7 with COPD, 1 with ACOS, 6 were post infective BE. Six patients were classified as idiopathic. Non productive cough was the main symptom of COPD patients, while purulent sputum was always present in asthmatics. Patients with post-infective BE complained non productive cough and dyspnea, while those with idiopathic BE had very variable symptoms. Cough and mucus production directly correlate with the number of involved lobes, P. aeruginosa is present in more productive cough. Conclusions: Patients with BE seems to have heterogeneous clinical presentation depending on comorbidities and extension of the diseases. Two prevalent phenotypes are those with COPD or asthma as associated disorders.