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)
Thromboembolic disease
Spinal pathology
Solid tumour
Rheumatoid arthritis / osteoarthritis
Pulmonary hypertension
Peripheral vascular disease
Obstructive sleep apnoea
Myocardial infarction
Morbid obesity
Metastatic malignancy / Leukaemia / Lymphoma
Irritable Bowel Disease
Iron deficiency anaemia
Immune deficiency
High cholesterol
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.