Clinical and Diagnostic Implications of the Bronchiectasis - COPD Association
Authors: Constantin Ancuţa Alina , Mihălţan Florin Dumitru 
Published: July 2021

Abstract
The aim of this study is to provide partially updated data on observational, non-interventional research that aims to determine the potential clinical and diagnostic implications of the association of bronchiectasis in patients with COPD.
Both COPD and bronchiectasis are two chronic lung diseases with a high prevalence in the general population and can coexist in a large number of cases. Their coexistence is increasingly diagnosed in clinical practice, but this association has not yet been well studied. The overlap of these two pathological entities has been established as a unique phenotype, because patients are prone to more severe and frequent exacerbations. It is therefore important to identify and study the presence of bronchiectasis in patients with COPD, as the clinical, prognostic, and therapeutic implications are different.

Materials and methods. The study was based on a cohort of 100 patients (n) with a positive diagnosis of COPD, following the establishment of the 2 study groups as follows: patients who were identified to also associate the diagnosis of bronchiectasis (x), these being the second study group, the first group including the remaining COPD patients without bronchiectasis (n-x). Therefore, the study, conducted between 2018-2020, contains 100 patients who addressed the Marius Nasta Institute of Pneumoftiziology, Bucharest, managed and followed for 12 months after inclusion, according to the developed scientific research protocol.
Patients were included in the study after an anamnesis as complete as possible and subsequent completion of the informed consent form. The ethical aspects were respected by the existence of the agreement of the Ethics Commission of the Institute of Pneumoftiziology “Marius Nasta”, Bucharest, for the study and by the presence of the informed consent of the patient (attached to each medical record / per hospitalized patient).
The comparative evaluation of the 2 groups of patients, group I (COPD) and group II (COPD and Bronchiectasis), consisted of periodic clinical-paraclinical monitoring (T0, T3, T6, T12), highlighting the negative impact of the presence of bronchiectasis in patients with COPD.

Results. The study cohort includes 100 patients: group I - 38 patients (diagnosis of COPD) and group II - 62 patients (diagnosis of COPD + BE), 20% being female patients. The mean age of the patients was 65.26 years. The occurrence of “de novo” bronchiectasis was identified in 4.84% of patients. Lung lobes involvement was identified in patients in group II, COPD + BE confirmed, while patients in group I had no bronchial damage. The number of exacerbations was higher in patients with BCOS.
The presence of infections with potentially pathogenic microorganisms and, in particular, with Pseudomonas aeruginosa, is a variable frequently associated with the presence of bronchiectasis in patients with COPD, being considered a predictor of mortality in these patients.

Discussions. BCOS syndrome is a time and resources consumer, so early diagnosis is essential to improve patients’ quality of life and increase survival.

Conclusions. COPD and Bronchiectasis are two conditions commonly encountered in current practice, with relatively similar clinical, pathophysiological and molecular consequences, and overlap syndrome has a higher risk of morbidity and mortality compared to each of the conditions taken separately. This study highlighted the negative impact of bronchiectasis in patients with COPD, clinically by increasing the number of exacerbations, affecting the quality of life, and reducing survival. Early identification of this phenotype, entitled BCOS in the literature, is necessary because therapeutic management is influenced by the particular clinical-paraclinical evidence of this new clinical syndrome.
Although the data obtained in this paperwork were in absolute agreement with the data of other existing studies in the literature, the number of patients included in the study was not high enough, and the pandemic context of the COVID-19 that broke out in Romania in March 2020 had quite obvious negative repercussions on the course of the study.