Suspected Bronchiectasis and Mortality in Adults With a History of Smoking Who Have Normal and Impaired Lung Function : A Cohort Study

Authors

Alejandro A Diaz
Wei Wang
Jose L Orejas
Rim Elalami
Wojciech R Dolliver
Pietro Nardelli
Ruben San José Estépar
Bina Choi
Carrie L Pistenmaa
James C Ross
Diego J Maselli
Andrew Yen
Kendra A Young
Gregory L Kinney
Michael H Cho
Raul San José Estépar

Language

English

Publication Date

10-1-2023

Journal

Annals of Internal Medicine

DOI

10.7326/M23-1125

PMID

37782931

PMCID

PMC10809158

PubMedCentral® Posted Date

4-3-2024

PubMedCentral® Full Text Version

Author MSS

Abstract

Background: Bronchiectasis in adults with chronic obstructive pulmonary disease (COPD) is associated with greater mortality. However, whether suspected bronchiectasis-defined as incidental bronchiectasis on computed tomography (CT) images plus clinical manifestation-is associated with increased mortality in adults with a history of smoking with normal spirometry and preserved ratio impaired spirometry (PRISm) is unknown.

Objective: To determine the association between suspected bronchiectasis and mortality in adults with normal spirometry, PRISm, and obstructive spirometry.

Design: Prospective, observational cohort.

Setting: The COPDGene (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease) study.

Participants: 7662 non-Hispanic Black or White adults, aged 45 to 80 years, with 10 or more pack-years of smoking history. Participants who were former and current smokers were stratified into normal spirometry (n = 3277), PRISm (n = 986), and obstructive spirometry (n = 3399).

Measurements: Bronchiectasis identified by CT was ascertained using artificial intelligence-based measurements of an airway-to-artery ratio (AAR) greater than 1 (AAR >1), a measure of bronchial dilatation. The primary outcome of "suspected bronchiectasis" was defined as an AAR >1 of greater than 1% plus 2 of the following: cough, phlegm, dyspnea, and history of 2 or more exacerbations.

Results: Among the 7662 participants (mean age, 60 years; 52% women), 1352 (17.6%) had suspected bronchiectasis. During a median follow-up of 11 years, 2095 (27.3%) died. Ten-year mortality risk was higher in participants with suspected bronchiectasis, compared with those without suspected bronchiectasis (normal spirometry: difference in mortality probability [Pr], 0.15 [95% CI, 0.09 to 0.21]; PRISm: Pr, 0.07 [CI, -0.003 to 0.15]; obstructive spirometry: Pr, 0.06 [CI, 0.03 to 0.09]). When only CT was used to identify bronchiectasis, the differences were attenuated in the normal spirometry (Pr, 0.04 [CI, -0.001 to 0.08]).

Limitations: Only 2 racial groups were studied. Only 1 measurement was used to define bronchiectasis on CT. Symptoms of suspected bronchiectasis were nonspecific.

Conclusion: Suspected bronchiectasis was associated with a heightened risk for mortality in adults with normal and obstructive spirometry.

Primary funding source: National Heart, Lung, and Blood Institute.

Keywords

Humans, Adult, Female, Middle Aged, Male, Cohort Studies, Prospective Studies, Artificial Intelligence, Pulmonary Disease, Chronic Obstructive, Lung, Smoking, Bronchiectasis, Spirometry, Forced Expiratory Volume

Published Open-Access

yes

Recommended Citation

Diaz, Alejandro A; Wang, Wei; Orejas, Jose L; et al., "Suspected Bronchiectasis and Mortality in Adults With a History of Smoking Who Have Normal and Impaired Lung Function : A Cohort Study" (2023). Faculty, Staff and Student Publications. 6700.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/6700