Clinical features associated with a doctor-diagnosis of bronchiectasis in the Severe Asthma Network in Italy (SANI) registry

ABSTRACT

Background

Several severe asthma comorbidities have been identified: an emerging one is bronchiectasis. We evaluated the frequency of bronchiectasis on severe asthma in a real-life setting, through the ‘Severe Asthma Network Italy’ (SANI) registry.

Methods

SANI registry encompasses demographic, clinical, functional and inflammatory data of Italian severe asthmatics. Data obtained by the enrolled patients were analyzed, focusing the attention on those patients with concomitant clinically relevant bronchiectasis.

Results

About 15.5% patients have bronchiectasis. Bronchiectasis diagnosis was associated with a higher prevalence of chronic rhinosinusitis with nasal polyps (54.6% vs. 38%, p = 0.001) and higher serum IgE levels (673.4 vs. 412.1 kUI/L, p = 0.013). Patients with bronchiectasis had worse asthma control (ACT: 16.7 vs 18.2, p = 0.013), worse quality of life (AQLQ: 4.08 vs. 4.60, p = 0.02) and lower lung function (FEV₁% predicted 67.3 vs. 75.0, p = 0.002). A higher rate of severe asthma exacerbations in the previous 12 months (85.2% vs. 61.5%, p < 0.001) was found in patients with bronchiectasis.

Conclusion

severe asthma associated with bronchiectasis represents a particularly severe asthma variant, possibly driven by an eosinophilic endotype. We, therefore, suggest that bronchiectasis should necessarily be assessed in severe asthmatic patients.

KEYWORDS:

• Severe asthma
• registry
• bronchiectasis
• real-life
• phenotypes

Article highlights

• Bronchiectasis is a common comorbidity of severe asthma

• Severe asthmatics with bronchiectasis have worse asthma control and quality of life

• Bronchiectasis is associated with worse lung function and increased exacerbation rate in patients with severe asthma

• Long-term oral corticosteroid therapy was more frequent in severe asthmatics with bronchiectasis

• Our study suggests that proper bronchiectasis should be necessarily assessed in severe asthmatics

Declaration of interest

F Blasi discloses grants and personal fees from AstraZeneca, Chiesi, GSK, Pfizer and Insmed, grants from Bayer, and personal fees from Guidotti, Grifols, Menarini, Mundipharma, Novartis and Zambon, outside the submitted work. P Paggiaro discloses grants and personal fees from AstraZeneca, Chiesi, Novartis and Sanofi, and personal fees from GlaxoSmithKline, Guidotti, Mundipharma, outside the submitted work. S Aliberti discloses grants and personal fees from Bayer Healthcare, Aradigm Corporation, Grifols, Chiesi, INSMED, personal fees from AstraZeneca, Basilea, Zambon, Novartis, Raptor, Actavis UK Its, Horizon, outside the submitted work. G W Canonica discloses grants as well as a lecture or advisory board fees from A. Menarini, Alk-Abello, Allergy Therapeutics, AstraZeneca, Boehringer-Ingelheim, Chiesi Farmaceutici, Genentech, Guidotti-Malesci, Glaxo Smith Kline, Hal Allergy, Mylan, Merck, Mundipharma, Novartis, Regeneron, Sanofi-Aventis, Sanofi-Genzyme, StallergenesGreer, UCB pharma, Uriach Pharma, Valeas, ViborPharma. E Heffler discloses participation to advisory boards and personal fees from AstraZeneca, Sanofi, GSK, Novartis, Circassia, Nestlè Purina, Boehringer Ingheleim, Valeas, outside the submitted work.

Reviewer disclosures

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

Author contributions

Enrico Heffler, Francesco Blasi, Pierluigi Paggiaro, Gianenrico Senna and Giorgio Walter Canonica designed the study, conducted the analyses, critically revised the results, contributed in writing the article and critically revised its final version.

Giacomo Malipiero, Giovanni Paoletti, Manuela Latorre, Marco Caminati, Giovanna Elisiana Carpagnano, Nunzio Crimi, Antonio Spanevello and Stefano Aliberti critically interpreted the results, and contributed in writing the article and critically revised its final version.

Additional information

Funding

The Severe Asthma Network in Italy (SANI) is supported through unrestricted grants by AstraZeneca, Glaxo Smith Kline, Novartis & Sanofi Genzyme.