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Bronchiectasis is common in severe asthma

Katerina Dimakou1,2, Adamantia Liapikou1,2, Michail Toumbis1,2, Anna Gkousiou3, Serafeim Chrysikos1,2, Kyriaki Tsikritsaki1,2, Loukas Thanos4 and Christina Triantafyllidou1,2
15th Pulmonary Department, Sotiria Chest Hospital, Athens, Greece,?26th Pulmonary Department, Sotiria Chest Hospital, Athens, Greece,?3American College, American College, Derree, Athens, Greece,?4Radiology Department, Sotiria Chest Hospital, Athens, Greece

Introduction: Bronchiectasis may contribute to severe asthma.

Aim: To estimate the presence of bronchiectasis in severe asthma and the relation with the clinical and functional parameters.

Methods: We included patients with severe uncontrolled asthma.Symptoms, number of exacerbations/year, courses of corticosteroids and antibiotics/year, spirometry, and bronchial colonization were estimated. The Smith scale for bronchiectasis was estimated by HRCT (score 0-24), taking a score≥3 as radiologically significant.

Results: Forty patients were studied, 28 women, mean age 57.9 years, 32 non smokers. Mean ACT score was 14.2.The main symptoms were: cough (92%), wheezing (95%), dyspnea (92%), sputum production (72%) of which mucoid (52%), mucopurulent and purulent (48%). Exacerbations: 4.4/year, corticosteroid courses/year:4.4, antibiotic courses/year:2.8.In 27 patients (67,5%) bronchiectasis was diagnosed: score 5.2.

The mean FEV1 was 72.6%. Nine patients (22.5%) were colonized with pathogens, 6 of whom with Pseudomonas Aeruginosa. Patients with sputum production had a higher smith score compared to those without expectoration (p=0.005). Patients with pathogens in sputum cultures had a higher smith score compared to those with normal flora (p<0.0001).

No correlation was found between the extent of bronchiectasis and the lung function parameters.The severity of bronchiectasis was correlated to the number of antibiotic courses/year (p=0.002). Lower ACT score was related with a higher asthma exacerbation rate (p=0.001).

Conclusion: The evidence of bronchiectasis on HRCT is common in patients with severe asthma. Sputum production and pathogen isolation may indicate the presence of this comorbidity and the need of antibiotics as an additional treatment.

PDPI Jatim. 02/03/17.

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