Quantitative computed tomography features and clinical manifestations associated with the extent of bronchiectasis in patients with moderate-to-severe COPD

Figures & data

Figure 1 Flowchart of the study population.

Abbreviations: CT, computed tomography; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; PMF, progressive massive fibrosis; TB, tuberculosis.

Figure 2 Quantitative CT analysis of emphysema and bronchial wall thickness.

Notes: (A) CT attenuation masks show areas of less than −950 HU (green areas). (B) Cross-sectional image shows segmentation of the airway wall at the origin of left apicoposterior segmental bronchi.
Abbreviations: CT, computed tomography; HU, Hounsfield unit.

Table 1 Factors associated with bronchiectasis in a logistic regression model (adjusted for sex, smoking, and BMI)

Factors	B	Exp (B)	95% CI	P-value
Male	−0.0108	0.979	0.171–5.597	0.981
Current smoker	0.0472	0.962	0.185–4.998	0.896
Former smoker	−0.1331	0.803	0.163–3.964	0.697
BMI	−0.0319	0.969	0.850–1.104	0.632
Previous TB	0.7316	4.320	1.735–10.753	0.002
Age	0.0282	1.029	0.970–1.091	0.348
BDR, FEV1	−0.3816	0.466	0.181–1.199	0.113

Note: Data in bold are statistically significant.

Abbreviations: B, B coefficient; BDR, bronchodilator reversibility; BMI, body mass index; FEV₁, forced expiratory volume in 1 second; TB, tuberculosis.

Figure 3 Distribution of bronchiectasis.

Note: The left lingua was considered an independent lobe.

Table 2 Characteristics of 127 patients in association with the extent of bronchiectasis

Parameter	No bronchiectasis	Mild bronchiectasis	Moderate-to-severe bronchiectasis	P-value
Subjects, n (%)	54 (42.5)	51 (40.2)	22 (17.3)
Age*	69.8 ± 8.1	72.5 ± 6.9	73.7 ± 7.3	0.064
Male	47 (87.0)	43 (84.3)	17 (77.3)	0.570
Smoking status				0.866
Current	18 (34.0)	19 (38.0)	6 (28.6)
Former	25 (47.2)	21 (42.0)	9 (42.9)
Never	10 (18.9)	10 (20.0)	6 (28.6)
Pack-years smoked*	27.6 ± 24.4	29.6 ± 23.4	40.3 ± 31.4	0.243
GOLD grade				0.013
Grade 2	45 (83.3)	48 (94.1)	14 (63.6)
Grade 3	9 (16.7)	2 (3.9)	7 (31.8)
Grade 4	0 (0.0)	1 (2.0)	1 (4.6)
BMI,* kg/m^2	23.2 ± 3.1	23.0 ± 3.5	20.8 ± 3.2	0.015
Previous TB	8 (14.8)	21 (41.2)	11 (50.0)	0.002
Pneumoconiosis	5 (9.3)	2 (3.9)	1 (4.6)	0.497
MMRC§	10/23/6/9/5	10/21/6/11/2	3/7/4/5/2	0.927
CAT score*	18.7 ± 10.7	17.9 ± 8.7	21.3 ± 10.3	0.425
Respiratory symptom
Cough	34 (63.0)	36 (70.6)	19 (86.4)	0.129
Sputum	39 (72.2)	39 (76.5)	18 (81.8)	0.665
Dyspnea	27 (50.0)	31 (60.8)	13 (59.1)	0.510
History of pneumonia	6 (11.5)	3 (6.1)	3 (14.3)	0.763
History of asthma	14 (26.9)	8 (16.3)	5 (23.8)	0.296
Exacerbations
Steroid treatment	1 (1.9)	1 (2.0)	1 (4.6)	0.740
Hospital admissions	2 (3.7)	1 (2.0)	2 (9.5)	0.333
WBC,* ×10^3 μL	7.0 ± 2.0	6.8 ± 1.9	6.4 ± 1.6	0.418
Segmenter neutrophils,* μL	4,120.0 ± 1,630.1	4,069.4 ± 1,489.1	3,910.7 ± 1,146.9	0.859
Eosinophils,* μL	169.4 ± 130.5	188.1 ± 146.7	223.8 ± 426.2	0.609
Albumin,* g/dL	4.1 ± 0.4	4.1 ± 0.5	4.0 ± 0.3	0.210
IL-6,* pg/mL	2.1 ± 2.6	2.5 ± 3.0	4.1 ± 4.2	0.059
IL-8,* pg/mL	15.3 ± 13.0	18.1 ± 23.1	15.7 ± 8.1	0.728
CRP,* mg/dL	0.2 ± 0.3	0.3 ± 0.4	0.5 ± 0.8	0.066
BDR, FEV1	19 (35.2)	9 (17.7)	3 (13.6)	0.049
BDR, FVC	18 (33.3)	18 (35.3)	4 (18.2)	0.327
FVC,* %	85.3 ± 15.2	87.7 ± 14.5	85.5 ± 20.2	0.699
FEV1,* %	64.7 ± 11.8	66.3 ± 10.7	57.1 ± 14.6	0.010
FEV1/FVC,* ratio	56.0 ± 7.6	55.3 ± 8.2	49.2 ± 11.7	0.007
Mean WA*	70.8 ± 4.6	69.8 ± 6.0	69.5 ± 5.4	0.500
E/I-ratioMLD*	0.9 ± 0.0	1.0 ± 0.0	1.0 ± 0.0	0.042
EI*	9.5 ± 7.8	8.8 ± 8.0	12.4 ± 11.0	0.260

Notes: Data shown are frequencies; those in parentheses are percentages.

* Data shown are the mean ± SD values, unless indicated otherwise.

§ Data shown as number of scores for each mMRC grade from 0–4, respectively. Data in bold are statistically significant.

Abbreviations: BDR, bronchodilator reversibility; BMI, body mass index; CAT, COPD assessment test; CRP, C-reactive protein; EI, emphysema index; E/I-ratio_MLD, expiratory to inspiratory ratio of mean lung density; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; IL, interleukin; MMRC, Modified Medical Research Council; TB, tuberculosis; WA, wall area; WBC, white blood cell.

Table 3 Factors associated with mild bronchiectasis in a logistic regression model (adjusted for sex, smoking, and BMI)

Factors	B	Exp (B)	95% CI	P-value*
Male	−0.0302	0.941	0.155–5.735	0.948
Current smoker	0.1686	1.190	0.215–6.601	0.664
Former smoker	−0.1632	0.854	0.164–4.449	0.653
BMI	0.0470	1.048	0.902–1.218	0.540
Previous TB	0.6359	3.567	1.360–9.352	0.010
Age	0.0423	1.043	0.979–1.111	0.191
BDR, FEV1	−0.4965	0.370	0.132–1.040	0.059

Note:

* Data in bold are statistically significant.

Abbreviations: B, B coefficient; BDR, bronchodilator reversibility; BMI, body mass index; FEV₁, forced expiratory volume in 1 second; TB, tuberculosis.

Table S1 The interview questionnaire

Category	Items
Respiratory symptoms	Mark all symptoms that have been in the past 12 months
	When did the current respiratory symptoms first occur?
	Do you still have symptoms?
	Select all when respiratory symptoms get worse
Cough	Since when did you have a cough?
	Do you have a cough for 3 months or more during the year?
	Do you have sputum when you cough?
	How often have you had a cough in the past year?
	Mark how often you cough by dividing into daytime and nighttime
Sputum	Since when did you have sputum?
	Do you have sputum for consecutive 3 months or more during the year?
	Do you have more than 2 years of sputum persisting for more than 3 months a year?
	Do you have a lot of sputum during the day?
Wheezing	Since when did wheezing occur?
	How often have you been wheezing in the past year?
	Do you have symptoms of chest tightness or dyspnea when you wheeze?
Dyspnea	Since when did dyspnea occur?
	How often have you had difficulty in breathing during the past year?
Severity and frequency of exacerbation	Have you been treated with antibiotics or steroids during the past year due to exacerbation of worsened respiratory symptoms (cough, dyspnea, wheezing, etc)? (except hospitalization)
	Have you “been hospitalized” for the past year due to exacerbation of respiratory symptoms (cough, dyspnea, wheezing, etc)?
Drug history
Smoking	What is your smoking status?
	Have you experienced secondhand smoking because of family or coworkers?
Rhinitis symptoms	Do you have at least one of the following: nasal obstruction, runny nose, sneezing, or itchy nose/eyes?
	Since when did you have rhinitis symptoms (nasal obstruction, runny nose, sneezing, or itchy nose/eyes?
	How frequently do rhinitis symptoms occur?
	Are you uncomfortable with rhinitis symptoms in daily life?
Past medical history of respiratory disease
Resident history (past 40 years)	List where you lived, where you were born and how long you have lived (from the present to the past)
Occupational history	Have you worked full time (more than 30 hours a week) for more than 6 months?
	Have you worked in a dusty workplace?
	Have you been exposed to gas or chemical vapors in your workplace?
	What was your main job in your longest career?
	What is your most recent job?
	Are you currently engaged in agriculture?
	How many years have you been engaged in agriculture?
	Do you regularly incinerate crops every year? If you do, how often do you regularly incinerate crops?
	Have you engaged in agriculture in the past?
	If you have, how many years did you engage in agriculture?
	Did you regularly incinerate crops every year in the past?
	If you did, how often did you regularly incinerate crops?
	Have you worked in a job using firewood? If you have, how often have you used firewood?
Household heating and fuel	Did you use one of the following for heating in the past year: firewood stove (including fireplace), coal stove, electric heater, or portable fuel/gas heater?
	What kind of fuel do you use for household heating?
	What kind of fuel do you commonly use for cooking?
	If you use any kind of gas for cooking, how do you light it?
	Have you used cooking stoves or ovens for household heating during the last winter? If “yes,” how often did you use?
	For cooking and/or heating, have you ever been exposed to fuels of wood or charcoal?
	Among plant and animal waste fuel, which of the following was the most exposed for cooking and/or heating?
	When was your first exposure to plant or animal waste fuel?
	Are you being exposed to plant or animal waste fuel? (including a month ago)
	How many hours are you being exposed to plant or animal waste fuel?
	At what age did the exposure to plant or animal waste fuel disappear completely?
	How many hours have you been exposed to plant or animal waste fuel a day?
Others	What is your current marital status?
	What is your educational background?
	What is your household’s monthly average income (total household income)?
Surgical history
Family history
Physical activity	Do you regularly exercise enough to get sweat?
	If you do, how many times do you exercise a week?
	I usually exercise for about minutes.
	What kind of exercise are you doing?
	How many hours did you do household chores a week in the past year?
	How many stairs a day did you go up and down in daily life for the past year?
	How many hours did you go for a walk in the past year?
24 h recall method for diet

Table S2 Demographics of moderate-to-severe COPD patients with or without bronchiectasis

Values	All patients	COPD without bronchiectasis	COPD with bronchiectasis	P-value
Subjects, n (%)	127 (100.0)	54 (42.5)	73 (57.5)
Age*	71.5 ± 7.6	69.8 ± 8.1	72.9 ± 7.0	0.024
Male	107 (84.3)	47 (87.0)	60 (82.2)	0.459
Smoking status				0.830
Current	43 (34.7)	18 (34.0)	25 (35.2)
Former	55 (44.3)	25 (47.2)	30 (42.3)
Never	26 (21.0)	10 (18.9)	16 (22.5)
Pack-years smoked*	30.3 ± 25.2	27.6 ± 24.4	32.6 ± 26.0	0.345
GOLD grade				0.387
Grade 2	107 (84.2)	45 (83.3)	62 (84.9)
Grade 3	18 (14.2)	9 (16.7)	9 (12.3)
Grade 4	2 (1.6)	0 (0.0)	2 (2.7)
BMI*, kg/m^2	22.7 ± 3.4	23.1 ± 3.1	22.3 ± 3.6	0.194
Previous TB	40 (31.5)	8 (14.8)	32 (43.8)	0.001
Pneumoconiosis	8 (6.3)	5 (9.3)	3 (4.1)	0.490
MMRC§	23/51/16/25/9	10/23/6/9/5	13/28/10/16/4	0.939
CAT score*	18.8 ± 9.9	18.7 ± 10.7	18.9 ± 9.3	0.904
Respiratory symptoms
Cough	89 (70.1)	34 (63.0)	55 (75.3)	0.132
Sputum	96 (75.6)	39 (72.2)	57 (78.1)	0.447
Dyspnea	71 (55.9)	27 (50.0)	44 (60.3)	0.249
History of pneumonia	12 (9.8)	6 (11.5)	6 (8.6)	0.717
History of asthma	27 (22.1)	14 (26.9)	13 (18.6)	0.451
Exacerbations	7 (5.6)	3 (5.6)	4 (5.6)	0.985
Steroid treatment	3 (2.4)	1 (1.9)	2 (2.8)	0.727
Hospital admissions	5 (4.0)	2 (3.7)	3 (4.2)	0.883
Death, n (%)	4 (3.2)	3 (5.6)	1 (1.4)	0.182
WBC*, ×10^3 μL	6.8 ± 1.9	7.0 ± 2.0	6.7 ± 1.8	0.337
Segmenter neutrophils*, μL	4,063.4 ± 1,490.7	4,120.0 ± 1,630.1	4,021.6 ± 1,388.8	0.715
Eosinophils*, μL	186.3 ± 215.3	169.4 ± 130.5	198.9 ± 261.1	0.448
Albumin*, g/dL	4.1 ± 0.3	4.1 ± 0.4	4.1 ± 0.3	0.452
IL-6*, pg/mL	2.6 ± 3.1	2.1 ± 2.6	3.0 ± 3.4	0.145
IL-8*, pg/mL	16.5 ± 17.1	15.3 ± 13.0	17.4 ± 19.9	0.526
CRP*, mg/dL	0.3 ± 0.5	0.2 ± 0.3	0.3 ± 0.6	0.119
BDR, FEV1, n (%)	31 (24.4)	19 (35.2)	12 (16.4)	0.015
BDR, FVC, n (%)	40 (31.5)	18 (33.3)	22 (30.1)	0.701
FVC*, %	86.3 ± 14.8	85.3 ± 15.2	87.0 ± 14.5	0.518
FEV1*, %	64.0 ± 12.3	64.7 ± 11.8	63.5 ± 12.6	0.573
FEV1/FVC*, ratio	54.5 ± 9.0	56.0 ± 7.6	53.5 ± 9.8	0.122
Mean WA*	70.2 ± 5.4	70.8 ± 4.6	69.7 ± 5.8	0.244
E/I-ratioMLD*	1.0 ± 0.0	0.9 ± 0.0	1.0 ± 0.0	0.016
EI*	9.7 ± 8.5	9.5 ± 7.8	9.9 ± 9.1	0.769

Notes: Data shown are frequencies; those in parentheses are percentages.

* Data shown are the mean ± SD values, unless indicated otherwise.

§ Data shown as number of scores for each mMRC grade from 0–4, respectively. Data in bold are statistically significant.

Abbreviations: BDR, bronchodilator reversibility; BMI, body mass index; CAT, COPD assessment test; CRP, C-reactive protein; EI, emphysema index; E/I-ratio_MLD, expiratory to inspiratory ratio of mean lung density; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; IL, interleukin; MMRC, modified Medical Research Council; TB, tuberculosis; WA, wall area; WBC, white blood cell.