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Factors Associated With Lung Function Decline in Adult Patients With Stable Non-Cystic Fibrosis Bronchiectasis^*

^* From the Pneumology Unit (Drs. Martínez-García and Soler-Cataluña) and Service of Internal Medicine (Dr. Román-Sánchez), Requena General Hospital, Valencia, Spain; Service of Pneumology (Dr. Perpiñá-Tordera), La Fe University Hospital, Valencia, Spain; and the Program of Epidemiology and Clinical Research (Dr. Soriano), Fundació Caubet-CIMERA, Illes Baleares, Mallorca, Spain.

Correspondence to: Miguel Angel Martínez-García, MD, Unidad de Neumología, Hospital General de Requena, Paraje Casa Blanca s/n, 43230, Valencia, Spain; e-mail: miangel{at}comv.es

Abstract

Background: Bronchiectasis remains a major public health problem, but factors influencing its natural history are not well characterized. The objective of our study was to explore modifiable and nonmodifiable factors associated with lung function decline in a clinical cohort of patients with stable non-cystic fibrosis (CF) bronchiectasis.

Methods: Seventy-six stable adult patients (mean age, 69.9 years; 48.7% men) with bronchiectasis were included. The diagnosis of bronchiectasis was established in all cases by high-resolution CT scanning. Baseline data were collected on clinical history, symptoms, disease extension, treatment, sputum volume, microbiological aspects, laboratory findings, and exacerbations. All patients were invited to attend the clinic every 6 months for 24 months to conduct full spirometry and microbiological analysis of sputum, and to report the number of exacerbations.

Results: Overall, the group experienced a rate of decline of lung function (FEV₁) of 52.7 mL per year. Independent factors associated with an accelerated decline of lung function were chronic colonization with Pseudomonas aeruginosa (PA) [odds ratio (OR), 30.4; 95% confidence interval (CI), 3.8 to 39.4; p = 0.005], more frequent severe exacerbations (OR, 6.9; 95% CI, 2.3 to 10.5; p = 0.014), and more systemic inflammation (OR, 3.1; 95% CI, 1.9 to 8.9; p = 0.023). Regrettably, none of the long-term treatment strategies evaluated, including the use of long-acting inhaled bronchodilators, inhaled or oral steroids, oxygen therapy, secretion clearance maneuvers, or antibiotics had a significant effect on FEV₁ decline.

Conclusion: Chronic colonization by PA, severe exacerbations, and systemic inflammation are associated with disease progression in non-CF bronchiectasis.

Key Words: bronchiectasis • exacerbations • inflammation • natural history • Pseudomonas aeruginosa

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