https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850679/

Zhang SQ, Xiong XF, Wu ZH, Huang TT, Cheng DY. Clinical features of asthma with comorbid bronchiectasis: A systematic review and meta-analysis. Medicine (Baltimore). 2021;100(4):e23858. doi:10.1097/MD.0000000000023858

Clinical Features of Asthma with Comorbid Bronchiectasis

Abstract

Background:

This meta-analysis aimed to systematically estimate the prevalence of comorbid bronchiectasis in patients with asthma and to summarize its clinical impact.

Methods:

Embase, PubMed, and Cochrane Library electronic databases were searched to identify relevant studies published from inception until March 2020.

Study Selection:

Studies were included if bronchiectasis was identified by high-resolution computed tomography. Outcomes included the prevalence of bronchiectasis and its association with demographic characteristics and indicators of asthma severity, including results of lung function tests and the number of exacerbations.

Results:

Five observational studies with 839 patients were included. Overall, the mean prevalence of bronchiectasis in patients with asthma was 36.6% (307/839). Patients with comorbid bronchiectasis had lower forced expiratory volume in 1 second (FEV₁)/forced vital capacity (FVC) (MD: −2.71; 95% CI: −3.72 to −1.69) and more frequent exacerbations (MD: 0.68; 95% CI: 0.03 to 1.33) than those with asthma alone, and there was no significant difference of sex, duration of asthma and serum levels of immunoglobulin(Ig)Es between asthmatic patients with or without bronchiectasis.

Conclusion:

The presence of bronchiectasis in patients with asthma was associated with greater asthma severity. There are important therapeutic implications of identifying bronchiectasis in asthmatic patients.

Summary:

This was a recent meta-analysis which looked at the prevalence of bronchiectasis in patients with asthma, and discussed the clinical effect of it. This analysis includes 5 observational studies (2 prospective and 3 retrospective) with 839 patients with asthma, of which 307 (36.6%) of patients had comorbid bronchiectasis. The prevalence of bronchiectasis in patients with asthma varied from between 2% to 80% in the different studies. Results showed that in patients with asthma and bronchiectasis, airway obstruction was more severeà they had a lower post-bronchodilator FEV1/FVC ratio (mean difference was -2.71), and had a more frequent incidence of asthma exacerbations in the previous year (mean difference of .75 and 1.20 in 2 studies, but only .06 in a third study). They found no significant difference in FEV1/predicted between the 2 groups.

Other interesting findings were that blood eiosinophil levels were higher in those with asthma and bronchiectasis (mean difference of .18), and these patients were older than those without bronchiectasis (mean difference of 7.2 years). However, there was no significant difference in sex, smoking history, and duration of asthma between the patients in the 2 groups.

The study concluded clinically that patients with comorbid asthma and bronchiectasis may need more specified treatment which targets chronic mucus production and bacterial infection in addition to regular recommended asthma treatments, in order to better improve symptoms and reduce risk of future exacerbations.

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