Bronchiectasis in severe uncontrolled asthma: A common feature

The presence of bronchiectasis may contribute to severity of asthma and affect its managment. Thus, we estimated the incidence of bronchiectasis and its correlation with the clinical and functional parameters in severe asthma. High resolution computed tomography was performed in all patients and Smith scale for bronchectasis was assesed. Thirty patients (20 women) with partly controlled (20%) or uncontrolled asthma (80%), mean aged of 57 years (30-83) were studied. Twenty two of them were non smokers. The main symptoms were: cough (90%), wheezing (96,6%), dyspnea (96,6%), and expectoration (76,6%). The latter was mucoid (47,8%), mucopurulent (43,5%), and purulent (8,7%). The mean duration of asthma was 15,9 years (2-50), the frequency of exacerbations was 4,6/ year (0-10), the number of systemic steroid cycles/year was 4,6 (0-12), and the number of antibiotic cycles/year was 3 (0-9). The mean FEV 1 was 67,6% of pred, (46-128), FVC 79,8% of pred. (46-128), and FEV 1 /FVC 68,2% (43-83). Seven patients (23,3%) were colonized with pathogens. Bronchiectasis (smith score ≥3) was diagnosed in 24 patients (80%). The severity of bronchiectasis was correlated with the number of antibiotic cycles/year (p=0,016), the positive sputum culture and the sputum quality (p= 0,006). The positive sputum culture was also correlated with the number of antibiotic cycles/year (p= 0,0003), and sputum quality (p= 0,0035). In conclusion, in patients with severe uncontrolled asthma the incidence of bronchiectasis on HRCT is very high. Bronchial colonization and sputum purulence may indicate the presence of this comorbidity and the need of antibiotics as an additional treatment.