Relationship between clinical and radiological signs of bronchiectasis in COPD patients: Results from COSYCONET - 05/10/20

Doi : 10.1016/j.rmed.2020.106117

Kathrin Kahnert ^a,^⁎,^{^{1
Both authors contributed equally.}} , Rudolf A. Jörres ^b,^{^{1
Both authors contributed equally.}}, Hans-Ulrich Kauczor ^c,^d,^e, Jürgen Biederer ^c,^d,^e,^f, Bertram Jobst ^c,^d, Peter Alter ^g, Frank Biertz ^h, Pontus Mertsch ^a, Tanja Lucke ^b, Johanna I. Lutter ⁱ, Franziska C. Trudzinski ^j, Jürgen Behr ^a, Robert Bals ^k, Henrik Watz ^l, Claus F. Vogelmeier ^g, Tobias Welte ^m
COSYCONET Study-Group
Andreas Stefan ⁿ, Bals Robert ^o, Behr Jürgen ^p, Kahnert Kathrin ^p, Bewig Burkhard ^q, Thomas Bahmer ^q, Buhl Roland ^r, Ewert Ralf ^s, Stubbe Beate ^s, Ficker Joachim H ^t, Gogol Manfred ^u, Grohé Christian ^v, Hauck Rainer ^w, Held Matthias ^x, Jany Berthold ^x, Henke Markus ^y, Herth Felix ^z, Höffken Gerd ^aa, Katus Hugo A ^ab, Kirsten Anne-Marie ^ac, Watz Henrik ^ac, Koczulla Rembert ^ad, Kenn Klaus ^ad, Kronsbein Juliane ^ae, Kropf-Sanchen Cornelia ^af, Lange Christoph ^ag, Zabel Peter ^ag, Pfeifer Michael ^ah, Randerath Winfried J ^ai, Seeger Werner ^aj, Studnicka Michael ^ak, Taube Christian ^al, Teschler Helmut ^al, Timmermann Hartmut ^am, Virchow J. Christian ^an, Vogelmeier Claus ^ao, Wagner Ulrich ^ap, Welte Tobias ^aq, Wirtz Hubert ^ar
ⁿ Lungenfachklinik, Immenhausen, Germany
^o Universitätsklinikum des Saarlandes, Germany
^p Klinikum der Ludwig-Maximilians-Universität München, Germany
^q Universitätsklinikum Schleswig Holstein, Germany
^r Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Germany
^s Universitätsmedizin Greifswald, Germany
^t Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität Nürnberg, Germany
^u Institut für Gerontologie, Universität Heidelberg, Germany
^v Ev. Lungenklinik Berlin, Germany
^w Kliniken Südostbayern AG, Kreisklinik Bad Reichenhall, Germany
^x Klinikum Würzburg Mitte gGmbH, Standort Missioklinik, Germany
^y Asklepios Fachkliniken München-Gauting, Germany
^z Thoraxklinik Heidelberg gGmbH, Germany
^aa Fachkrankenhaus Coswig GmbH, Germany
^ab Universitätsklinikum Heidelberg, Germany
^ac Pneumologisches Forschungsinstitut an der Lungenclinic Grosshansdorf GmbH, Germany
^ad Schön Klinik Berchtesgadener Land, Germany
^ae Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
^af Universitätsklinikum Ulm, Germany
^ag Forschungszentrum Borstel, Germany
^ah Klinik Donaustauf, Germany
^ai Wissenschaftliches Institut Bethanien e. V., Solingen, Germany
^aj Justus-Liebig-Universität Gießen, Germany
^ak Uniklinikum Salzburg, Germany
^al Ruhrlandklinik gGmbH Essen, Germany
^am Hamburger Institut für Therapieforschung GmbH, Germany
^an Universitätsklinikum Rostock, Germany
^ao Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Germany
^ap Klinik Löwenstein gGmbH, Germany
^aq Medizinische Hochschule Hannover, Germany
^ar Universitätsklinikum Leipzig, Germany

Names of participating study nurses
Doris Lehnert ^as, Birte Struck ^at, Lenka Krabbe ^au, Barbara Arikan ^ah, Julia Tobias ^ah, Gina Spangel ^av, Julia Teng ^av, Ruhrlandklinik gGmbH. Essen ^av, Jeanette Pieper ^aw, Margret Gleiniger ^aw, Britta Markworth ^aw, Zaklina Hinz ^aw, Petra Hundack-Winter ^aw, Ellen Burmann ^ax, Katrin Wons ^ay, Ulrike Rieber ^az, Beate Schaufler ^az, Martina Seibert ^ba, Katrin Schwedler ^bb, Sabine Michalewski ^bc, Sonja Rohweder ^bc, Campus Kiel ^ar, Patricia Berger ^ar, Diana Schottel ^bd, Manuel Klöser ^be, Vivien Janke ^bf, Rosalie Untsch ^bg, Jana Graf ^bh, Anita Reichel ^bi, Gertraud Weiß ^ad, Erich Traugott ^ad, Barbara Ziss ^ad, Ilona Kietzmann ^bj, Michaela Schrade-Illmann ^bk, Beate Polte ^bk, Cornelia Böckmann ^bl, Gudrun Hübner ^bl, Lena Sterk ^bl, Anne Wirz ^bl
^ad Schön Klinik Berchtesgadener Land, Germany
^ah Klinik Donaustauf, Germany
^ar Universitätsklinikum Leipzig, Germany
^as Evangelische Lungenklinik Berlin, Germany
^at Bergmannsheil Berufsgenossenschaftliches Universitätsklinikum Bochum, Germany
^au Medizinische-Klinik Borstel, Germany
^av Kornelia Speth, Universitätsklinikum Gießen, Germany
^aw Pneumologisches Forschungsinstitut Großhansdorf, Germany
^ax Hamburger Institut für Therapieforschung Hamburg, Germany
^ay Sylvia Wagner Medizinische Hochschule Hannover, Germany
^az Thoraxklinik am Universitätsklinikum Heidelberg, Germany
^ba Universitätsklinikum des Saarlandes, Homburg, Saar, Germany
^bb Lungenfachklinik Immenhausen, Germany
^bc Universitätsklinikum Schleswig-Holstein, Germany
^bd Krankenhaus Lindenbrunn, Coppenbrügge, Germany
^be Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Germany
^bf Universitätsklinikum Marburg, Germany
^bg Asklepios Fachkliniken, München-Gauting, Germany
^bh Klinikum der Universität München, Germany
^bi Klinikum Nürnberg, Germany
^bj Wissenschaftliches Institut Bethanien für Pneumologie e. V, Solingen, Germany
^bk Universitätsklinikum-Ulm, Germany
^bl Klinikum Würzburg Mitte gGmbH, Standort Missioklinik, Würzburg, Germany

^a Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, 80336, Munich, Germany
^b Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany
^c Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
^d Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany
^e University of Latvia, Faculty of Medicine, Raina bulvaris 19, Riga, LV-1586, Latvia
^f Christian-Albrechts-Universität zu Kiel, Faculty of Medicine, D-24098, Kiel, Germany
^g Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany, Member of the German Center for Lung Research (DZL), Baldingerstrasse, 35043, Marburg, Germany
^h Institute for Biostatistics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
ⁱ Institute of Epidemiology, Helmholtz Zentrum München (GmbH) – German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), 85764, Neuherberg, Germany
^j Thoraxklinik-Heidelberg gGmbH, Röntgenstraße 1, 69126, Heidelberg, Germany
^k Department of Internal Medicine V – Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Kirrberger Straße 1, 66424, Homburg, Germany
^l Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Woehrendamm 80, 22927, Grosshansdorf, Germany
^m Department of Pneumology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

^∗Corresponding author. Department of Internal Medicine V, University of Munich, Ziemssenstr. 1, 80336, Munich, Germany.Department of Internal Medicine VUniversity of MunichZiemssenstr. 1Munich80336Germany

Abstract

Bronchiectasis (BE) might be frequently present in COPD but masked by COPD symptoms. We studied the relationship of clinical signs of bronchiectasis to the presence and extent of its radiological signs in patients of different COPD severity.

Visit 4 data (GOLD grades 1–4) of the COSYCONET cohort was used. Chest CT scans were evaluated for bronchiectasis in 6 lobes using a 3-point scale (0: absence, 1: ≤50%, 2: >50% BE-involvement for each lobe).

1176 patients were included (61%male, age 67.3y), among them 38 (3.2%) with reported physicians’ diagnosis of bronchiectasis and 76 (6.5%) with alpha1-antitrypsin deficiency (AA1D). CT scans were obtained in 429 patients. Within this group, any signs of bronchiectasis were found in 46.6% of patients, whereby ≤50% BE occurred in 18.6% in ≤2 lobes, in 10.0% in 3–4 lobes, in 15.9% in 5–6 lobes; >50% bronchiectasis in at least 1 lobe was observed in 2.1%. Scores ≥4 correlated with an elevated ratio FRC/RV. The clinical diagnosis of bronchiectasis correlated with phlegm and cough and with radiological scores of at least 3, optimally ≥5.

In COPD patients, clinical diagnosis and radiological signs of BE showed only weak correlations. Correlations became significant with increasing BE-severity implying radiological alterations in several lobes. This indicates the importance of reporting both presence and extent of bronchiectasis on CT. Further research is warranted to refine the criteria for CT scoring of bronchiectasis and to determine the relevance of radiologically but not clinically detectible bronchiectasis and their possible implications for therapy in COPD patients.

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Highlights

•	Bronchiectasis (BE) might be frequently present in COPD but masked by COPD symptoms.
•	In COPD patients diagnosis and radiological signs of BE showed weak correlations.
•	Correlations became significant with increasing BE-severity.
•	Importance of reporting both, presence and extent, of bronchiectasis on CT in COPD.

Le texte complet de cet article est disponible en PDF.

Keywords : COPD, Bronchiectasis, CT scan, Lung function, Symptoms

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Relationship between clinical and radiological signs of bronchiectasis in COPD patients: Results from COSYCONET - 05/10/20

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