Coexistence of bronchiectasis with asthma, chronic rhinosinusitis common

Coexisting bronchiectasis in patients with asthma and chronic rhinosinusitis is common and associated with more severe disease, according to new findings published in BMC Pulmonary Medicine.

“Although there have been several studies involving the association of bronchiectasis with asthma or chronic rhinosinusitis, to date, whether bronchiectasis exists and correlates with asthma-chronic rhinosinusitis patients has not been fully elucidated,” Haiyan Sheng, MD, from the department of respiratory and critical care medicine at Beijing Tongren Hospital at Capital Medical University, and colleagues wrote. “In this study, we aimed to assess the prevalence, inflammatory characteristics and clinical implications of bronchiectasis in a prospective cohort of asthma-chronic rhinosinusitis patients.”

Researchers conducted a prospective study that involved 176 patients with both asthma and chronic rhinosinusitis (mean age, 53.9 years; 50.6% men). Researchers obtained bronchiectasis diagnosis and severity using thorax high-resolution CT, the Smith radiology scale and the Bhalla scoring system. Then, the researchers analyzed clinical data, fraction of exhaled nitric oxide, peripheral blood eosinophil counts and lung function for correlations with bronchiectasis.

Seventy-two patients with asthma and chronic rhinosinusitis (40.9%) were diagnosed with bronchiectasis.

Patients with asthma-chronic rhinosinusitis and overlapping bronchiectasis had higher incidence rates of nasal polyps (P = .004), higher Lund-Mackay scores (P = .044), higher proportion of one or more severe asthma exacerbation within the past 12 months (P = .003), lower post-bronchodilator FEV₁ percent predicted (P = .006) and elevated peripheral blood eosinophil counts (P = .022) compared with patients without bronchiectasis. Researchers noted a positive correlation between Smith and Bhalla scores with nasal polyps and a negative correlation with FEV₁ percent predicted and BMI. The following factors differentiated bronchiectasis in patients with asthma-chronic rhinosinusitis: FEV₁ percent predicted of 71.4% or less, peripheral blood eosinophil counts greater than 0.6 x 10⁹/L, presence of nasal polyps and one or more severe asthma exacerbations in the past 12 months.

“Subgroups of asthma-chronic rhinosinusitis patients with nasal polyps, more severely impaired lung function, higher circulating levels of eosinophils and more frequent acute asthma attacks should receive high-resolution CT examination for earlier diagnosis and treatment of bronchiectasis,” the researchers wrote.