Comorbidities in Bronchiectasis
Bronchiectasis is a complex, multi-component disease which is characterised by chronic systemic inflammation. It frequently co-exists with comorbidities, which may be the underlying cause of bronchiectasis, may exist in synergy or be coincidental. It has been recently found that people with a diagnosis of bronchiectasis have an average of 2 to 6 other conditions (McDonnell et al 2016).
The most common comorbidities are cardiovascular disease, gastro-oesophageal reflux disease (GORD), psychological illness, pulmonary hypertension and cognitive impairment.
Other comorbidities are outlined in Table 1
| Table 1 Comorbidities in bronchiectasis |
|---|
| Gastrooesophageal reflux disease (GORD) |
| Valvulopathy |
| Tuberculosis |
| Thromboembolic disease |
| Spinal pathology |
| Solid tumour |
| Rheumatoid arthritis / osteoarthritis |
| Pulmonary hypertension |
| Psoriasis |
| Peripheral vascular disease |
| Osteoporosis |
| Obstructive sleep apnoea |
| Myocardial infarction |
| Morbid obesity |
| Metastatic malignancy / Leukaemia / Lymphoma |
| Irritable Bowel Disease |
| Iron deficiency anaemia |
| Immune deficiency |
| Hypertension |
| High cholesterol |
| Gout |
| Diabetes mellitus |
| Depression or anxiety |
| COPD or asthma |
| Connective tissue disease |
| Congestive heart failure |
| Cognitive impairment |
| Chronic Kidney disease or Liver Disease |
| Cerebrovascular Accident or Transient Ischaemic Attack |
| Atrial fibrillation |
| Allergic bronchopulmonary aspergillosis |
To understand the clinical significance of comorbidities, the Bronchiectasis Aetiology Comorbidity Index has been devised as a method of predicting morbidity and exacerbation rates and a poorer quality of life. Within the tool, the identification of a number of comorbidities including metastatic malignancy, COPD, inflammatory bowel disease, iron deficient anaemia, asthma, peripheral vascular disease, haematological malignancy, cognitive impairment, chronic liver disease, diabetes, pulmonary hypertension and ischaemic heart disease are selected. Based on this, an individual is deemed at low, intermediate or high risk of 5-year mortality and risk of hospitalisation for severe exacerbation.
