Clinical characteristics of patients with chronic obstructive pulmonary disease with comorbid bronchiectasis: a systemic review and meta-analysis

Figures & data

Figure 1 Flow diagram of search strategy and study selection.

Table 1 Characteristics of included studies

Study number	Authors	Publication year	Time frame of patients’ recruitment	Severity of COPD	Parameters under study
1	Fujimoto et al^Citation11	2006	September 2002 to September 2004	Moderate, severe	Sex, age, smoking history, onset of symptoms, BMI, α1-antitrypsin, eosinophil counts, daily sputum production, exacerbation rate, hospitalization rate, post-BD FEV1/FVC, post-BD FEV1, TLC, PaO2, PaCO2, response to β2-agonist
2	Martínez-García et al^Citation7	2011	January 2004 to December 2006	Moderate, severe	Sex, age, smoking history, onset of symptoms, daily sputum production, daily treatments, dyspnea MRC, exacerbation in previous year, acute antibiotic treatments, acute oral steroid treatments, fibrinogen, albumin, CRP, α1-antitrypsin, post-BD FEV1/FVC, post-BD FEV1, PPM colonization, Pseudomonas aeruginosa isolates, Haemophilus influenzae isolates
3	Bafadhel et al^Citation1	2011	Not mentioned	Not mentioned	Sex, age, smoking history, daily sputum production, sputum total cell count, exacerbation in previous year, BMI, SGRQ score, CRQ score, VAS score, ICS dosage, post-BD FEV1/FVC, post-BD FEV1
4	Martínez-García et al^Citation13	2013	January 2004 to February 2007	Moderate, severe	Sex, age, smoking history, onset of symptoms, daily sputum production, daily treatments, BMI, dyspnea MRC, exacerbation in previous year, acute antibiotic treatments, acute oral steroid treatments, all-cause mortality, albumin, CRP, α1-antitrypsin, post-BD FEV1/FVC, post-BD FEV1, post-BD FVC, PPM colonization, Pseudomonas aeruginosa isolates, Haemophilus influenzae isolates
5	Tulek et al^Citation12	2013	January 2010 to May 2012	Mild, moderate, severe, very severe	Age, smoking history, onset of symptoms, daily sputum production, exacerbation in previous year, albumin, CRP, ESR, post-BD FEV1/FVC, post-BD FE, V1, post-BD FVC
6	Gatheral et al^Citation4	2014	January 1998 to September 2008	Not mentioned	Sex, age, onset of symptoms, daily sputum production, post-BD FEV1/FVC, post-BD FEV1, PPM colonization, Pseudomonas aeruginosa isolates, Haemophilus influenzae isolates, respiratory admissions per year, nonrespiratory admissions per year, age at death

Abbreviations: BMI, body mass index; CRP, C-reactive protein; COPD, chronic obstructive pulmonary disease; CRQ, Chronic Respiratory Disease Interviewer-Administered Questionnaire; ESR, erythrocyte sedimentation rate; ICS, inhaled corticosteroid; MRC, Medical Research Council; post-BD FEV₁/FVC, ratio of postbronchodilation forced expiratory volume in 1 second and forced vital capacity; post-BD FEV₁, postbronchodilation forced expiratory volume in 1 second; PPM, potentially pathogenic microorganisms; SGRQ, Saint George’s Research Questionnaire score; TLC, total lung capacity; VAS, visual analog scale.

Table 2 Radiological characteristics of COPD patients in the included studies

Study number	CT slice thickness	N (with/without bronchiectasis)	Diagnostic criteria of bronchiectasis
1	1 mm collimation at 10 mm intervals	44/39	Method of Goddard et al^Citation23
2	1 mm collimation at 10 mm intervals	53/39	1) Lack of tapering of bronchi, 2) dilation of bronchi when the internal diameter was larger than that of the adjacent pulmonary artery, 3) visualization of the peripheral bronchi within 1 cm of the costal pleural surface or adjacent mediastinal pleural surface
3	1 mm collimation at 10 mm intervals	33/13	1) Lack of tapering of bronchi, 2) dilation of bronchi when the internal diameter was larger than that of the adjacent pulmonary artery, 3) visualization of the peripheral bronchi within 1 cm of the costal pleural surface or adjacent mediastinal pleural surface
4	1 mm collimation at 10 mm intervals	115/86	1) Lack of tapering of bronchi, 2) dilation of bronchi when the internal diameter was larger than that of the adjacent pulmonary artery, 3) visualization of the peripheral bronchi within 1 cm of the costal pleural surface or adjacent mediastinal pleural surface
5	1 mm collimation at 10 mm intervals	27/26	Bhalla scoring system^Citation24
6	1 mm or 2.5 mm or 5 mm or 7 mm collimation at 10 mm intervals	278/128	1) Lack of tapering of bronchi, 2) dilation of bronchi when the internal diameter was larger than that of the adjacent pulmonary artery, 3) visualization of the peripheral bronchi within 1 cm of the costal pleural surface or adjacent mediastinal pleural surface

Note: Refer Table 1 for details of studies.

Abbreviations: COPD, chronic obstructive pulmonary disease; CT, computed tomography.

Table 3 Evaluation of quality of included studies

Agency for Healthcare Research and Quality standard for cross-sectional study quality	Study number
	1	2	3	4	5	6
Define the source of information	Yes	Yes	Yes	Yes	Yes	Yes
List inclusion and exclusion criteria for exposed and unexposed subjects (cases and controls) or refer to previous publications	Yes	Yes	Yes	Yes	Yes	Yes
Indicate time period used for identifying patients	Yes	Yes	No	Yes	Yes	Yes
Indicate whether or not subjects were consecutive if not population based	Yes	Yes	Yes	Yes	Yes	Yes
Indicate if evaluators of subjective components of study were masked to other aspects of the status of the participants	Yes	Yes	No	No	Yes	No
Describe any assessments undertaken for quality assurance purposes	No	Yes	No	No	Yes	Yes
Explain any patient exclusions from analysis	Yes	Yes	Yes	Yes	Yes	Yes
Describe how confounding was assessed and/or controlled	Unclear	Yes	Unclear	Yes	Yes	Unclear
If applicable, explain how missing data were handled in the analysis	–	–	–	Yes	–	–
Summarize patient response rates and completeness of data collection	Yes	Yes	Yes	Yes	Yes	Yes
Clarify what follow-up, if any, was expected and the percentage of patients for which incomplete data or follow-up was obtained	Yes	–	–	Yes	–	Yes

Note: Refer Table 1 for details of studies.

Figure 2 Forest plot of mean difference of age in COPD patients with and without bronchiectasis.

Abbreviations: CI, confidence interval; SD, standard deviation; COPD, chronic obstructive pulmonary disease; IV, inverse variance.

Figure 3 Forest plot of odds ratios of sex in COPD patients with and without bronchiectasis.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; M–H, Mantel-Haenszel method.

Figure 4 Forest plot of mean difference of smoking history (pack-years) in COPD patients with and without bronchiectasis.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; IV, inverse variance; SD, standard deviation.

Figure 5 Forest plot of odds ratios of daily sputum production in COPD patients with and without bronchiectasis.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; M–H, Mantel-Haenszel method.

Figure 6 Forest plot of mean difference in exacerbations in COPD patients with and without bronchiectasis.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; IV, inverse variance; SD, standard deviation.

Figure 7 Forest plot of mean difference of postbronchodilator FEV₁/FVC% in COPD patients with and without bronchiectasis.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; IV, inverse variance; SD, standard deviation.

Figure 8 Forest plot of mean difference of postbronchodilator FEV₁% predicted in COPD patients with and without bronchiectasis.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; FEV₁%, forced expiratory volume in 1 second; IV, inverse variance; SD, standard deviation.

Figure 9 Forest plot of mean difference of CRP in COPD patients with and without bronchiectasis.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; CRP, C-reactive protein; IV, inverse variance; SD, standard deviation.

Figure 10 Forest plot of mean difference of albumin in COPD patients with and without bronchiectasis.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; IV, inverse variance; SD, standard deviation.

Figure 11 Forest plot of odds ratios of chronic PPM colonization in COPD patients with and without bronchiectasis.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; M–H, Mantel-Haenszel method; PPM, potentially pathogenic microorganisms.

Figure 12 Forest plot of odds ratios of Pseudomonas aeruginosa isolation in COPD patients with and without bronchiectasis.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; M–H, Mantel-Haenszel method.

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