Clinical Characteristics Of Patients With Bronchiectasis And Bronchial Asthma

Background:Non-cystic fibrosis bronchiectasis is characterized by irreversibly dilated bronchi and usually associated with the production of chronic sputum,bacterial colonization of the lower respiratory tract,inflammation and frequent exacerbations~1.Although its prevalence in most areas is not clear,with the development of high-resolution computed tomography((HRCT))as a detection tool,bronchiectasis is increasingly considered to be an important respiratory disease in developing countries~2.Patients with bronchiectasis suffer from repeated acute aggravations due to respiratory tract infection and inflammation,which often leads to hospitalization.In the long run,recurrent exacerbations can lead to progressive deterioration of lung function~3.Asthma is a heterogeneous disease characterized by repeated onsets,with three different characteristics:airway obstruction,airway hyperreactivity and airway inflammation~4.It is often caused by exercise,exposure to allergens or stimulants,weather changes,or viral respiratory tract infections~5.Bronchiectasis and asthma coexist in many patients.However,few studies have been undertaken to investigate the relationship between the two diseases.Purpose:The purpose of this study is to summarize the clinical characteristics of asthma in patients with bronchiectasis and analyze the relationship between asthma and bronchiectasis.Methods:Data were collected retrospectively from inpatients diagnosed with bronchiectasis with or without asthma at the Affiliated Hospital of Zhejiang University School of Medicine from January 2017 to December 2019.Patients who only met the diagnostic criteria of bronchiectasis were classified as simple bronchiectasis group,while Patients who met the diagnostic criteria of bronchiectasis and asthma at the same time were classified as bronchiectasis and bronchial asthma coexisting group.The information of the two groups of patients such as the demographic characteristics,clinical manifestations,laboratory indexes and pulmonary function examination,was collected,and the data were sorted out and analyzed by SPSS 23.0 software.Results:1. From general baseline information,the average age of 257 patients in simple bronchiectasis group was 64.56±13.453,of which 118 patients were male and 139patients were female.The average age of 115 patients in bronchiectasis and bronchial asthma coexisting group was 63.90±10.555,of which 48 patients were male and 67patients were female.Age and gender differences were not statistically significant(P>0.05).The average BMI of 257 patients in simple bronchiectasis group was20.53±3.694 kg/m~2,and 115 patients in bronchiectasis and bronchial asthma coexisting group was 21.62±3.890 kg/m~2.The difference of BMI was statistically significant(P<0.05).2. In personal history,53 out of 257 patients in simple bronchiectasis group had a history of smoking and 37 patients had a history of drinking.23 out of 115 patients in bronchiectasis and bronchial asthma coexisting group had a history of smoking and 12patients had a history of drinking.There was no statistical significance in the difference of smoking history and drinking history(P>0.05).In the previous history of diseases,of the 257 patients in simple bronchiectasis group,1 patient had bronchocephalitis,27patients had tuberculosis and 3 patients had allergic rhinitis.Of the 115 patients in bronchiectasis and bronchial asthma coexisting group,9 patients had tuberculosis and 3patients had allergic rhinitis.There were no statistical differences in previous history of diseases(P>0.05).3. In terms of clinical manifestation,the average age of illness in the 257 simple bronchiectasis group was 19.49±16.538 years.The average age of illness in the 115bronchiectasis and bronchial asthma coexisting group was 20.98±17.460 years.The difference was not statistically significant(P>0.05).There were 105 positive cases of pulmonary auscultation in simple bronchiectasis group,comprising 6 heard rhonchi,76heard moist rales and 23 heard dry and wet rales.There were 53 positive cases of pulmonary auscultation in bronchiectasis and bronchial asthma coexisting group,of which 1 was heard rhonchi,48 were heard moist rales,and 8 were heard dry and wet rales.The difference was not statistically significant(P>0.05).4. In terms of the total serum Ig E,44 of the 257 patients in simple bronchiectasis group were tested for the total serum Ig E with the medium of 38.80(15.10,87.65)U/m L,and51 of the 115 patients in bronchiectasis and bronchial asthma coexisting group were tested for the total serum Ig E with the medium of 73.00(26.40,434.00)U/m L.From the aspect of the total serum Ig E level,the differences between both groups of patients were not statistically significant(P>0.05).A total of 73 cases(28.40%)were positive for sputum culture in simple bronchiectasis group,including 48 cases of Pseudomonas aeruginosa,8 cases of Candida albicans,2 cases of Acinetobacter baumannii,8 cases of Klebsiella pneumoniae,3 cases of Haemophilus influenzae,1 case of Aspergillus,1case of Streptococcus aureus,1 case of Escherichia coli and 1 case of Staphylococcus aureus.A total of 35 cases(30.43%)were positive for sputum culture in bronchiectasis and bronchial asthma coexisting group,including 20 cases of Pseudomonas aeruginosa,3 cases of Candida albicans,4 cases of Acinetobacter baumannii,4 cases of Klebsiella pneumoniae,1 case of Haemophilus influenzae,2 cases of Aspergillus and 1 case of Enterobacter cloacae.There was no significant difference in the positive rate of sputum culture between the two groups(P>0.05).5. In terms of pulmonary function,104 patients in simple bronchiectasis group underwent pulmonary function tests,with FEV1(L)averaging 1.63±0.725,FEV1predictive values(%)averaging 65.63±24.786,FVC(L)averaging 2.29±0.844 and FEV1/FVC(%)averaging 67.75±15.297.Pulmonary function tests were performed in66 patients in bronchiectasis and bronchial asthma coexisting group,with FEV1(L)averaging 1.24±0.498,FEV1 predictive values(%)averaging 49.38±19.365,FVC(L)averaging 2.06±0.875,and FEV1/FVC(%)averaging 53.98±13.881.The indexes of FEV1,FEV1(%)and FEV1/FVC(%)were statistically significant(P<0.05),but the difference of FVC was not statistically significant(P>0.05).Conclusion:1.Compared to the patients with bronchiectasis and bronchial asthma coexisting,the average BMI of patients with simple bronchiectasis was slower,indicating that the BMI of patients with bronchiectasis and bronchial asthma coexisting may not be affected by airway hyperreactivity.2.In the positive results for sputum culture in patients both with simple bronchiectasis and bronchiectasis and bronchial asthma coexisting,Pseudomonas aeruginosa accounts for a higher proportion.3.For patients with bronchiectasis and bronchial asthma coexisting,the indexes of pulmonary ventilation function were relatively poor and the airway resistance were greater.