Comorbidities and mortality risk factors for patients with bronchiectasis

ABSTRACT

Introduction: Comorbidities in patients with bronchiectasis are common and have a significant impact on clinical outcomes, contributing to lower quality of life, lung function, and exacerbation frequency. At least 13 comorbidities have been associated with a higher risk of mortality in bronchiectasis patients. Nonetheless, the kind of relationship between bronchiectasis and comorbidities is heterogeneous and poorly understood.

Areas covered: different biological mechanisms leading to bronchiectasis could have a role in the development of the associated comorbidities. Some comorbidities could have a causal relationship with bronchiectasis, possibly through a variable degree of systemic inflammation, such as in rheumatic disorders and bowel inflammatory diseases. Other comorbidities, such as COPD or asthma, could be associated through airway inflammation and there is an uncertain cause–effect relationship. Finally, shared risk factors could link different comorbidities to bronchiectasis such as in the case of cardiovascular diseases, where the known link between chronic systemic inflammation and pulmonary infection could play a significant role.

Expert opinion: Although different tools have been developed to assess the role of comorbidities in bronchiectasis , we believe that the implementation of current strategies to manage them is absolutely necessary and could significantly improve long-term prognosis in patients with bronchiectasis.

KEYWORDS:

• Bronchiectasis
• comorbidities
• chronic respiratory diseases

Article highlights

• Bronchiectasis is a complex, chronic and multi-etiological disease, and might coexist with diverse comorbidities, many of which can associate a worse disease prognosis and can be an independent risk of death.

• Etiology of Bronchiectasis should always be investigated, as it can help in the identification of related comorbidities and treatable traits.

• Chronic systemic inflammation could play a central role within the biological mechanisms involved in the development of comorbidities, such as cardiovascular diseases.

• Chronic respiratory diseases such as COPD and asthma frequently coexist with bronchiectasis, and should be also considered comorbidities, as they influence clinical outcomes.

• A number of comorbidities could be associated with bronchiectasis due to the fact they share common risk factors such as for the most common cardiovascular diseases. In fact, acute and chronic airway infections in bronchiectasis patients can trigger cardiovascular events with potentially significant prognostic consequences.

• Recommendations for identification and management of comorbidities in bronchiectasis should be integrated in clinical guidelines.

• Further research is needed to define the biological mechanisms involved in these associations, in order to identify possible biomarkers and treatment targets.

Acknowledgments

The authors thank Clare Butler for her careful review of English.

Declaration of interest

E Polverino has received different fees for talks at congresses or courses or for consultancy by Chiesi, Grifols, Zambon, Insmed. E Polverino has also received grants for research from Grifols and Chiesi to her Institution. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers in this manuscript have no relevant financial or other relationships to disclose.