作者
Eva Polverino,Anthony De Soyza,Katerina Dimakou,Letizia Traversi,Apostolos Bossios,Megan Crichton,Felix C. Ringshausen,Montserrat Vendrell,Pierre‐Régis Burgel,Charles Haworth,Michael R. Loebinger,Natalie Lorent,Isabell Pink,Melissa J. McDonnell,Sabina Škrgat,Luís Máiz,Oriol Sibila,Menno M. vd Eerden,Paula Kauppi,Amelia Shoemark,Adelina Amorim,Jeremy Brown,John R. Hurst,Marc Miravitlles,Rosario Menéndez,Antoní Torres,Tobias Welte,Francesco Blasi,Josje Altenburg,Michal Shteinberg,Wim Boersma,J.S. Elborn,Pieter Goeminne,Stefano Aliberti,James D. Chalmers
摘要
Rationale and Objective: Bronchiectasis and COPD are associated conditions but misdiagnosis is believed to be common. A recently published international consensus definition of bronchiectasis (BE) and COPD association: The ROSE criteria (radiological bronchiectasis(R), obstruction: FEV1/FVC ratio<0.7 (O), symptoms (S) and exposure:≥10 pack year smoking (E) allows objective diagnosis of the BE-COPD association. Methods: Analysis of the EMBARC registry, a prospective observational study of patients with CT confirmed bronchiectasis from 28 countries. The ROSE criteria were used to objectively defined BE-COPD association. Key outcomes during up to 5-years follow-up were exacerbations, hospitalization and mortality. Measurement and main results: 16730 patients with bronchiectasis were included. 4336 had a co-diagnosis of COPD and these patients had more exacerbations, worse quality of life and higher severity scores. We observed marked overdiagnosis of COPD using the ROSE criteria: 22.2% of patients with a diagnosis of COPD did not have airflow obstruction and 31.9% did not have a history of ≥10 pack years smoking. Therefore the proportion meeting the ROSE criteria for COPD was 2157 (55.4%). Compared to patients without COPD, patients meeting ROSE criteria had increased risk of exacerbations and exacerbations resulting in hospitalisation during follow-up (IRR 1.25 95%CI 1.15-1.35 and 1.69 95%CI 1.51-1.90 respectively) but patients with a diagnosis of COPD who did not meet ROSE criteria also had increased risk of exacerbations. Conclusions: The label of COPD is often applied to bronchiectasis patients without objective evidence of airflow obstruction and smoking history. Patients with a clinical label of COPD have worse clinical outcomes.