PURPOSE:To determine health status and risk factors for exacerbation in patients with symptomatic bronchiectasis.
METHODS:We followed 26 adult patients with bronchiectasis as part of an ongoing 12 month randomized trial of two secretion clearance devices. Entry criteria: at least two exacerbations requiring antibiotics during the preceding year, and chest CT scan confirmation of bronchiectasis. Exclusion criteria included cystic fibrosis. Exacerbations were defined as at least 2 of the following: change in color or volume of sputum, increased dyspnea, increased cough, and fever. Measurements obtained at baseline, 6 and 12 months: spirometry, cough peak flow, St George’s Respiratory Questionnaire (SGRQ), Cough Quality of Life Questionnaire (CQLQ).
RESULTS:Subjects had an average of 2.7 exacerbations per year requiring antibiotics. At baseline, the mean cough peak flow was 421 Lpm; FEV1: 1.77 liters (74%), FVC 2.62 liters (79%), and FEV1/FVC 68%. There was no significant change in mean FEV1 or FVC over the study period. At baseline, scores on the SGRQ and CQLQ were 39 and 53 respectively, neither of which correlated with subsequent clinical outcomes. There was a significant correlation between FEV1 %predicted, FVC %predicted and hospitalizations+urgent visits in these patients, with R of 0.55 and 0.58 (p<0.01) respectively, whereas cough peak flow did not predict this outcome (R = -0.116, p=0.4). There was also a significant correlation between baseline FEV1 %predicted, FVC %predicted and monthly exacerbation rate; R of 0.44 and 0.43 (p<0.05) respectively.
CONCLUSION:FEV1 and FVC are significantly associated with exacerbation and hospitalization rates in patients with symptomatic bronchiectasis. Force of cough measured by cough peak flow and symptoms as measured by SQRQ and CQLQ did not predict these clinical outcomes. Quality of life as measured by SQRQ indicated a level of impairment similar to that seen in several prior investigations of COPD. Subjects had relatively high impairment scores based on cough associated quality of life indices.
CLINICAL IMPLICATIONS:Spirometry may be an important tool in risk stratifying patients with symptomatic bronchiectasis.
DISCLOSURE:Plutarco Castellanos, No Financial Disclosure Information; No Product/Research Disclosure Information