Bronchiectasis in severe asthma: Clinical features and outcomes

Abstract Background Bronchiectasis are increasingly identified in subjects with severe asthma and could contribute to disease severity. Objective We aimed to determine the prevalence of bronchiectasis in our population of subjects with severe asthma and to better characterize the clinical features of these patients and their outcomes. Methods We retrospectively reviewed the medical files of 184 subjects with confirmed severe asthma who had undergone a high resolution thoracic computed tomography and compared the characteristics and outcomes of subjects with and without bronchiectasis. Results Bronchiectasis were identified in 86 (47%) patients. These patients had concomitant hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) (OR 2.24, 95% CI 1.00-5.03) and gastroesophageal reflux disease (GERD) (OR 1.89, 95% CI 1.05-3.41) more frequently than subjects without bronchiectasis, but less atopic dermatitis (OR 0.188, 95% CI 0.04-0.88). Subjects with bronchiectasis were more frequently hospitalized for asthma exacerbations (OR 2.09, 95% CI 1.08-4.05) and had higher blood eosinophil levels (464 vs 338, p 0.005) than subjects without bronchiectasis. Conclusion Our study suggests that in subjects with severe asthma, the presence of bronchiectasis is associated with more frequent hospitalizations, concomitant GERD, hypersensitivity to NSAIDs and higher blood eosinophilia. Bronchiectasis could represent an additional phenotypic feature of severe eosinophilic asthma.