0
Original Research |

Bronchiectasis Rheumatoid overlap syndrome (BROS) is an independent risk factor for mortality in patients with bronchiectasis: A multicentre cohort study

Anthony De Soyza; Melissa J. McDonnell, MD; Pieter C. Goeminne, MD, PhD; Stefano Aliberti, MD, PhD; Sara Lonni, MD; John Davison, RN; Lieven J. Dupont, MD, PhD; Thomas C. Fardon, MD; Robert M. Rutherford, MD; Adam T. Hill, MD; James D. Chalmers, MD PhD
Author and Funding Information

Funding: This study was in part funded by the Medical Research Council, UK. Anthony De Soyza acknowledges a HEFCE senior lectureship, support from the NIHR Biomedical Research Centre and MRC funding for a UK multicentre registry (BRONCH-UK).

James D Chalmers acknowledges fellowship support from the Medical Research Council and the Wellcome Trust. Melissa J McDonnell acknowledges fellowship support from the European Respiratory Society/European Lung Foundation and Health Research Board, Ireland. Levein J Dupont is a senior research fellow of the FWO. The following acknowledge support from an ERS Clinical Research Collaboration in bronchiectasis EMBARC : ADS, JC, SA, PG, MJM.

Conflicts of interest: Dr. Aliberti has received speaking fees and served on industry advisory committees for Bayer Healthcare, AstraZeneca, Griffols, Aradigm Corporation, Basilea, Zambon, Novartis, Raptor, Chiesi and Actavis UK Ltd. Dr. Chalmers has received grant funding from AstraZeneca, GlaxoSmithKline and Pfizer and fees for consulting or speaking from AstraZeneca, Pfizer, Napp and Boehringer-Ingelheim. All other authors declare no conflicts of interest in relation to the present study.

Corresponding Author: Anthony De Soyza Newcastle University.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2016.12.024
Text Size: A A A
Published online

Abstract

Introduction  We studied if Bronchiectasis (BR) and Rheumatoid arthritis (RA) when manifesting as an overlap syndrome (BROS) was associated with worse outcomes than other BR aetiologies applying the Bronchiectasis Severity Index (BSI).

Methods  We interrogated the Bronchiectasis Severity Index (BSI) databases of 1716 patients across 6 centres: Edinburgh, UK (608 patients), Dundee, UK (N=286), Leuven, Belgium (N=253), Monza, Italy (N=201), Galway Ireland (N=242) and Newcastle, UK (N=126). Patients were categorised as BROS (those with RA and Bronchiectasis without interstitial lung disease), idiopathic bronchiectasis, Bronchiectasis-COPD overlap syndrome (BCOS) and “other” BR aetiologies. Mortality rates, hospitalisation and exacerbation frequency were recorded.

Results  We identified 147 patients with BROS (8.5% of cohort). There was a statistically significant relationship between BROS and mortality although this was not associated with higher rates of bronchiectasis exacerbations or bronchiectasis-related hospitalisations. The mortality rate over a mean of 48 months was 9.3% for idiopathic BR, 8.6% in patients with “other” causes of BR, 18% for RA and 28.5% for BCOS. Mortality was statistically higher in BROS and BCOS compared with all other aetiologies. The BSI scores were statistically but not clinically significantly higher in those with BROS when compared to idiopathic BR (BSI mean 7.7 vs. 7.1 respectively, p <0.05). BCOS had significantly higher BSI scores (mean 10.4), Pseudomonas aeruginosa colonization rates (24%) and prior hospitalisation rates (58%).

Conclusions  Both BROS and BCOS groups have an excess of mortality -the mechanisms for this may be complex but these data highlight that these subgroups require additional study to understand this excess mortality.


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543