Type 2-High Severe Asthma with and without Bronchiectasis: A Prospective Observational Multicentre Study

Figures & data

Table 1 Clinical and Functional Characteristic of Type-2 High Severe Asthma Patients with and without Bronchiectasis

Total Population, n = 113			T2-SA, n = 63	T2-SA+BE n = 50	p
Age, years, mean (SD)		55 (11)	54.9 (11.4)	55.5 (11.7)	0.8107
Age at onset, years, mean (SD)		32.3 (15.5)	31.8 (16.2)	33 (14.7)	0.6792
Female, n (%)		67 (59.3)	39 (61.9)	28 (56)	0.5667
BMI, mean (SD)		26.1 (4.1)	26 (3.9)	26 (4.5)	0.8330
Obese (BMI ≥ 30), n (%)		23 (20.4)	12 (19)	11 (22)	0.8149
Positive Skin Prick Tests, n (%)		82 (72.6)	45 (71.4)	37 (74)	0.8336
Smoking history, n (%)	No	86 (76.1)	49 (77.8)	37 (74)	0.6629
	Current	9 (8)	4 (6.3)	5 (10)	0.5058
	Ex-smoker	18 (15.9)	10 (15.9)	8 (16)	>0.9999
CRS, n (%)		79 (69.9)	37 (58.7)	42 (84)	0.0040
CRSwNP, n (%)		54 (47.8)	27 (42.9)	27 (54)	0.0165
GERD, n (%)		52 (46)	31 (49.2)	21 (42)	0.4554
Chronic Mucus Hypersecretion, n (%)		44 (38.9)	15 (23.8)	29 (58)	0.0004
	Mucous	7 (6.2)	4 (6.4)	3 (6)	>0.9999
	Muco-purulent	28 (24.8)	10 (15.9)	18 (36)	0.0167
	Purulent	9 (8)	1 (1.6)	8 (16)	0.0100
High dose ICS-LABA, n (%)		113 (100)	63 (100)	50 (100)	>0.9999
LAMA, n (%)		78 (69)	43 (68.3)	35 (70)	>0.9999
Patients on OCS, n (%)		50 (44.2)	22 (34.9)	28 (56)	0.0357
Long-term macrolide therapy, n (%)		14 (12.4)	3 (4.8)	11 (22)	0.0084
Exacerbations/year, median (IQR)		8 (4 −12)	6 (4–12)	10 (4–12)	0.0487
ACT, median (IQR)		13 (9–16)	13 (10–16)	12 (9–16)	0.9046
FEV1, mL, mean (SD)		1969 (720)	1987 (687)	1947 (766)	0.7700
FEV1, % predicted, mean (SD)		70.7 (20.3)	70.8 (17.6)	70.6 (23.4)	0.9461
FEV1/FVC, %, mean (SD)		64.5 (14.2)	63.3 (14.3)	66.1 (14.1)	0.3522
Total IgE, UI/mL, median (IQR)		185 (93–474)	177 (87–401)	223 (95–559)	0.6203
Eosinophil counts in peripheral blood, cells/μL median (IQR)		500 (340–900)	480 (330–945)	635 (337–898)	0.6102
Patients with ≥300 eosinophils/μL, n (%)		93 (82.3)	51 (81)	42 (84)	0.8054
FeNO, ppb, median (IQR)		34 (17–56)	34 (15.5–54)	34.5 (18.5–67)	0.7456
Vitamin D, ng/dL, median (IQR)		21 (16–29)	21 (17–29)	21 (15–29)	>0.9999
Alpha-1 antitrypsin, mg/dL, median (IQR)		152 (130–170)	151 (135–179)	153 (122–166)	0.7980

Notes: Categorical variables are presented as numbers (n) and percentages (%). For normally distributed data, values are mean and standard deviation (SD). For non-normally distributed variables, values are median and interquartile range (IQR). Bold entries highlight statistically significant differences between Type 2-High Severe Asthma (T2-SA) and Type 2-High Severe Asthma + Bronchiectasis (T2-SA+BE).

Abbreviations: ACT, asthma control test; BMI, body mass index; CRS, chronic rhinosinusitis; CRSwNP, chronic rhinosinusitis with nasal polyps; GERD, gastroesophageal reflux disease; LABA, long-acting beta agonist; ICS, inhaled corticosteroids; LAMA, long-acting muscarinic antagonist; FeNO, fractional exhaled nitric oxide; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; IgE, immunoglobulin E.

Figure 1 Study flow chart.

Abbreviations: SA, severe asthma; BE, bronchiectasis.

Figure 2 Differences between Type-2 High Severe Asthma patients with and without Bronchiectasis with regard to chronic rhinosinusitis (A), chronic rhinosinusitis with nasal polyps (B), chronic sputum production (C), chronic oral corticosteroids intake (D) and asthma exacerbations in the previous year (E). Receiver operating characteristics (ROC) of the optimal regression model of variables (presence of chronic rhinosinusitis, chronic mucus hypersecretion and daily OCS intake) strongly associated with comorbid BE in T2-SA (F).

Abbreviations: T2-SA, type 2-high severe asthma; BE, bronchiectasis; CRS, chronic rhinosinusitis; CRSwNP, chronic rhinosinusitis with nasal polyps; OCS, oral corticosteroids.

Table 2 Radiological and Microbiological Features in Patients with T2-SA+BE

T2-SA+BE, n = 50
BHALLA score, median (IQR)	18.3 (16–20)
BHALLA, n (%)
Mild (16–25)	38 (76)
Moderate (9–15)	12 (24)
Severe (0–8)	0 (0)
Number of lobes with bronchiectasis, median (IQR)	3 (2–4)
Lobes involved, n (%)
Lower lobes	26 (52)
Upper lobes	4 (8)
Lower and upper lobes	10 (20)
Middle lobe	4 (8)
Middle and lower lobes	6 (12)
Bronchiectasis pattern distribution, n (%)
Peripheral	36 (72)
Central	4 (8)
Mixed	10 (20)
Types of bronchiectasis, n (%)
Cylindrical	48 (96)
Multiple types	2 (4)
BSI, median (IQR)	6 (4–8)
BSI, n (%)
Mild (0–4)	11 (22)
Moderate (5–8)	33 (66)
Severe (≥9)	6 (12)
Sputum cultures, n (%)
Negative	44 (88)
Pseudomonas aeruginosa	5 (10)
Stenotrophomonas maltophilia	1 (2)

Notes: Categorical variables were presented as numbers (n) and percentages (%). For non-normally distributed variables, values are median and interquartile range (IQR).

Abbreviation: BSI, Bronchiectasis Severity Index.

Figure 3 Bronchiectasis lobes involvement (A) and distribution pattern (B).

Figure 4 Distribution of patients in relation to Bhalla score items. Data as presented as percentage (%). 1. Severity of bronchiectasis: 0 = None; 1 = luminal diameter slightly larger than the adjacent vessel; 2 = bronchial diameter between 2 and 3 times the diameter of the adjacent vessel; 3 = bronchus is more than 3 times the diameter of the adjacent vessel. 2. Peribronchial thickening: 0 = None; 1 = wall thickness is similar to that of the surrounding vessel; 2 = wall thickness greater, but less than twice, the diameter of the adjacent vessel; 3 = more than twice the thickness of the adjacent vessel. 3. Extent of bronchiectasis: 0 = None; 1 = 1–5 segments; 2 = 6–9; 3 = >9. 4. Mucus plugs: 0 = None; 1 = 1–5 segments; 2 = 6–9; 3 = >9. 5. Sacculation/abscesses: 0 = None; 1 = 1–5 segments; 2 = 6–9; 3 = >9. 6. Generations of bronchial division involved: 0 = None; 1 = >4^a generations; 2 = >5^a; 3 = >6^a. 7. Bullae: 0 = None; 1 = unilateral; 2 = bilateral; 3 = >4. 8. Emphysema: 0 = None; 1 = 1–5 segments; 2 = >5. 9. Collapse/consolidation: 0 = None; 1 = subsegmental; 2 = segmental/lobar.

Figure 5 Correlations between BSI, ACT (A), FEV₁% (B) and FEV₁ mL (C).

Abbreviations: BSI, Bronchiectasis Severity Index; ACT, Asthma Control Test; FEV₁, forced expiratory volume in 1 second.