https://doi.org/10.4081/monaldi.2023.2718
Non-cystic fibrosis bronchiectasis: a retrospective review of clinical, radiological, microbiological and lung function profile at a tertiary care center of low-middle income country
Submitted: July 18, 2023
Accepted: August 28, 2023
Published: September 12, 2023
Accepted: August 28, 2023
Abstract Views: 936
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Non-cystic fibrosis (non-CF) bronchiectasis has emerged as a significant respiratory disease in developing countries. Given the variation in causes and clinical characteristics across different regions, it is necessary to conduct studies in regions with limited data such as low-middle income countries (LMIC). The aim of the study was to investigate the underlying causes, clinical presentation, etiology, lung function and imaging in patients with bronchiectasis who sought treatment at a tertiary care hospital in a LMIC. We conducted retrospective observational study at the Aga Khan University, Pakistan. Adult patients diagnosed with non-CF bronchiectasis on high-resolution computed tomography scan between 2000 and 2020 were included. We evaluated the etiology, clinical characteristics, microbiology, radiology and spirometric pattern of these patients. A total of 340 patients were included with 56.5% being female and 44.7% aged over 60 years. Among them, 157 (46.2%) had experienced symptoms for 1-5 years. The most common spirometric pattern observed was obstructive impairment (58.1%). Previous tuberculosis (TB) (52.94%) was the most common etiology followed by allergic bronchopulmonary aspergillosis (7.64%). Bilateral lung involvement on HRCT scan was found in 63.2% of patients. Pseudomonas aeruginosa was the most frequently identified organism (38.75%) among 240 patients with available specimens. Patients with P. aeruginosa infections had a significantly higher number of exacerbations (p=0.016). There was a significant difference (p<0.001) in P. aeruginosa growth among different etiologies. In conclusion, post-TB bronchiectasis was the most common cause of non-CF bronchiectasis in our study population. P. aeruginosa was the predominant organism, and 63.2% of the patients exhibited bilateral lung involvement. Since P. aeruginosa growth and extensive lung involvement have been associated with poor prognosis and increased mortality risk, we recommend close follow ups of these patients to improve quality of life and survival in developing countries like Pakistan.
Barker AF. Bronchiectasis. N Engl J Med 2002;346:1383-93.
DOI: https://doi.org/10.1056/NEJMra012519
Dimakou K, Triantafillidou C, Toumbis M, et al. Non CF-bronchiectasis: Aetiologic approach, clinical, radiological, microbiological and functional profile in 277 patients. Respir Med 2016;116:1-7.
DOI: https://doi.org/10.1016/j.rmed.2016.05.001
McGuinness G, Naidich DP. CT of airways disease and bronchiectasis. Radiol Clin North Am 2002;40:1-19.
DOI: https://doi.org/10.1016/S0033-8389(03)00105-2
Cole P. Inflammation: a two-edged sword--the model of bronchiectasis. Eur J of Respir Dis Suppl 1986;147:6-15.
McShane PJ, Naureckas ET, Tino G, Strek ME. Non–cystic fibrosis bronchiectasis. Am J Respir Crit Care Med 2013;188:647-56.
DOI: https://doi.org/10.1164/rccm.201303-0411CI
King PT, Holdsworth SR, Freezer N, et al. Characterisation of the onset and presenting clinical features of adult bronchiectasis. Respir Med 2006;100:2183-9.
DOI: https://doi.org/10.1016/j.rmed.2006.03.012
Pasteur MC, Helliwell SM, Houghton SJ, et al. An investigation into causative factors in patients with bronchiectasis. Am J Respir Crit Care Med 2000;162:1277-84.
Sharif N, Baig MS, Sharif S, Irfan M. Etiology, clinical, radiological, and microbiological profile of patients with non-cystic fibrosis bronchiectasis at a tertiary care hospital of Pakistan. Cureus 2020;12:e7208.
DOI: https://doi.org/10.7759/cureus.7208
Dhar R, Singh S, Talwar D, et al. Bronchiectasis in India: results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry. Lancet Glob Health 2019;7:e1269-e79.
Angrill J, Agusti C, De Celis R, et al. Bacterial colonisation in patients with bronchiectasis: microbiological pattern and risk factors. Thorax 2002;57:15-9.
DOI: https://doi.org/10.1136/thorax.57.1.15
Chandrasekaran R, Mac Aogáin M, Chalmers JD, et al. Geographic variation in the aetiology, epidemiology and microbiology of bronchiectasis. BMC Pulm Med 2018;18:83.
DOI: https://doi.org/10.1186/s12890-018-0638-0
King PT, Holdsworth SR, Freezer N, et al. Microbiologic follow-up study in adult bronchiectasis. Respir Med 2007;101:1633-8.
DOI: https://doi.org/10.1016/j.rmed.2007.03.009
Macfarlane J, McAlinden P, De Soyza A. P240 longitudinal study of sputum microbiology in adult non-CF bronchiectasis. Thorax 2010;65:A177-A8.
DOI: https://doi.org/10.1136/thx.2010.151068.41
Nicotra MB, Rivera M, Dale AM, et al. Clinical, pathophysiologic, and microbiologic characterization of bronchiectasis in an aging cohort. Ches. 1995;108:955-61.
DOI: https://doi.org/10.1378/chest.108.4.955
Olveira C, Padilla A, Martínez-García M-Á, et al. Etiology of bronchiectasis in a cohort of 2047 patients. An analysis of the Spanish historical bronchiectasis registry. Arch Bronconeumo 2017;53:366-74.
DOI: https://doi.org/10.1016/j.arbr.2017.05.005
Palwatwichai A, Chaoprasong C, Vattanathum A, et al. Clinical, laboratory findings and microbiologic characterization of bronchiectasis in Thai patients. Respirolog. 2002;7:63-6.
DOI: https://doi.org/10.1046/j.1440-1843.2002.00367.x
Goeminne P, Nawrot T, Ruttens D, et al. Mortality in non-cystic fibrosis bronchiectasis: a prospective cohort analysis. Respir Med 2014;108:287-96.
DOI: https://doi.org/10.1016/j.rmed.2013.12.015
Loebinger M, Wells A, Hansell D, et al. Mortality in bronchiectasis: a long-term study assessing the factors influencing survival. Eur Respir J 2009;34:843-9.
DOI: https://doi.org/10.1183/09031936.00003709
Onen ZP, Gulbay BE, Sen E, et al. Analysis of the factors related to mortality in patients with bronchiectasis. Respir Med 2007;101:1390-7.
DOI: https://doi.org/10.1016/j.rmed.2007.02.002
Chalmers JD, Chang AB, Chotirmall SH, et al. Bronchiectasis. Nat Rev Dis Primers 2018;4:45.
DOI: https://doi.org/10.1038/s41572-018-0042-3
Doğru D, Nik-Ain A, Kiper N, et al. Bronchiectasis: the consequence of late diagnosis in chronic respiratory symptoms. J Trop Pediatr 2005;51:362-5.
DOI: https://doi.org/10.1093/tropej/fmi036
Shahid S, Irfan M. Clinical features, microbiology and lung function in post-TB bronchiectasis compared to other aetiologies. Int J Tuberc Lung Dis 2022;26:992-4.
DOI: https://doi.org/10.5588/ijtld.22.0251
Aksamit TR, O’Donnell AE, Barker A, et al. Adult patients with bronchiectasis: a first look at the US bronchiectasis research registry. Chest 2017;151:982-92.
DOI: https://doi.org/10.1016/j.chest.2016.10.055
Pasteur MC, Helliwell SM, Houghton SJ, et al. An investigation into causative factors in patients with bronchiectasis. Am J Respir Crit Care Med 2000;162:1277-84.
DOI: https://doi.org/10.1164/ajrccm.162.4.9906120
World Health Organization. Global tuberculosis report 2022. Available from: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022
Pasteur MC, Bilton D, Hill AT. British Thoracic Society guideline for non-CF bronchiectasis. Thorax 2010;65:i1-i58.
DOI: https://doi.org/10.1136/thx.2010.136119
Quint JK, Millett ER, Joshi M, et al. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: a population-based cohort study. Eur Respir J 2016;47:186-93.
DOI: https://doi.org/10.1183/13993003.01033-2015
Ringshausen FC, Rademacher J, Pink I, et al. Increasing bronchiectasis prevalence in Germany, 2009–2017: a population-based cohort study. Eur Respir J 2019;54:1900499.
DOI: https://doi.org/10.1183/13993003.00499-2019
Davies G, Wells A, Doffman S, et al. The effect of Pseudomonas aeruginosa on pulmonary function in patients with bronchiectasis. Eur Respir J 2006;28:974-9.
DOI: https://doi.org/10.1183/09031936.06.00074605
Wilson C, Jones P, O'leary C, et al. Effect of sputum bacteriology on the quality of life of patients with bronchiectasis. Eur Respir J 1997;10:1754-60.
DOI: https://doi.org/10.1183/09031936.97.10081754
Çiftci F, Mülazimoglu DD, Erol S, yet al. Effect of sputum bacteriology on the prognosis of patients with acute exacerbations of bronchiectasis in the intensive care unit. Eurasian J Pulmonol 2018;20:85.
DOI: https://doi.org/10.5152/ejp.2017.96658
Ethics Approval
Given the retrospective chart reviews and lack of direct involvement of patients or other human participants, a waiver of ethics approval and informed consent was obtained from the Ethics Review Committee of the Aga Khan UniversityHow to Cite
Shahid, Shayan, Ali bin Abdul Jabbar, Abdullah Wagley, Muhammad Daniyal Musharraf, Haris Zahid, Syed Muhammad Zubair, and Muhammad Irfan. 2023. “Non-Cystic Fibrosis Bronchiectasis: A Retrospective Review of Clinical, Radiological, Microbiological and Lung Function Profile at a Tertiary Care Center of Low-Middle Income Country”. Monaldi Archives for Chest Disease, September. https://doi.org/10.4081/monaldi.2023.2718.
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