Bacteria and viruses and clinical outcomes of asthma-bronchiectasis overlap syndrome: A cohort study

IF 4.6 2区医学 Q2 ALLERGY

Clinical and Translational Allergy Pub Date : 2024-01-11 DOI:10.1002/clt2.12331

Xiao-xian Zhang, Jia-hui He, Cui-xia Pan, Zhen-feng He, Hui-min Li, Zhen-hong Lin, Xiao-fen Zhang, Lai-jian Cen, Ri-lan Zhang, Ming-xin Shi, Wei-jie Guan

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Abstract

Background

Despite the high prevalence of co-existing bronchiectasis and asthma (asthma-bronchiectasis overlap syndrome [ABOS]), little is known regarding the dominant pathogens and clinical correlates.

Objective

To investigate the bacteria and viruses which differentially dominate in ABOS (including its subtypes) compared with bronchiectasis alone, and determine their relevance with bronchiectasis severity and exacerbations.

Methods

This was a prospective observational cohort study conducted between March 2017 and August 2023. We included 81 patients with ABOS and 107 patients with bronchiectasis alone. At steady-state baseline, patients underwent comprehensive assessments and sputum collection for bacterial culture and viral detection (quantitative polymerase-chain-reaction). Patients were followed-up to record exacerbation and spirometry.

Results

Patients with ABOS had significantly higher symptom burden and exacerbation frequency than those with bronchiectasis alone. Despite similar pathogen spectrum, the rate of bacteria–virus co-detection increased less substantially at acute exacerbations (AE) onset than at steady-state compared with bronchiectasis alone. Pathogenic bacteria (particularly Pseudomonas aeruginosa) were detected fairly common (exceeding 50%) in ABOS and were associated with greater severity of bronchiectasis when stable and conferred greater exacerbation risks at follow-up. Viral but not bacterial compositions changed substantially at AE onset compared with clinical stability. Higher blood eosinophil count, moderate-to-severe bronchiectasis and non-atopy were associated with higher odds of bacterial, but not viral, detection (all p < 0.05).

Conclusion

Detection of bacteria or virus is associated with bronchiectasis severity or clinical outcomes in ABOS. This highlights the importance of integrating sputum microbial assessment for ascertaining the dominant pathophysiology (atopy vs. infection) and longitudinal trajectory prediction in ABOS.

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细菌和病毒与哮喘-支气管扩张重叠综合征的临床结果：一项队列研究

背景尽管支气管扩张和哮喘（哮喘-支气管扩张重叠综合征 [ABOS]）并存的发病率很高，但人们对主要病原体和临床相关性知之甚少。目的研究与单纯支气管扩张相比，在 ABOS（包括其亚型）中占主导地位的细菌和病毒，并确定它们与支气管扩张严重程度和病情加重的相关性。方法这是一项前瞻性观察性队列研究，研究时间为 2017 年 3 月至 2023 年 8 月。我们纳入了 81 名 ABOS 患者和 107 名单纯支气管扩张症患者。在稳态基线时，患者接受综合评估，并采集痰液进行细菌培养和病毒检测（定量聚合酶链式反应）。对患者进行随访，记录病情加重情况和肺活量。结果 ABOS 患者的症状负担和恶化频率明显高于单纯支气管扩张症患者。尽管病原体谱相似，但与单纯性支气管扩张症相比，细菌-病毒共同检测率在急性加重（AE）开始时的增加幅度小于稳定期。在 ABOS 中，病原菌（尤其是铜绿假单胞菌）的检出率相当高（超过 50%），在病情稳定时与支气管扩张的严重程度相关，在随访时会带来更大的病情加重风险。与临床稳定期相比，AE 发病时病毒（而非细菌）成分发生了重大变化。较高的血液嗜酸性粒细胞计数、中度至重度支气管扩张和无炎症与较高的细菌检测几率相关，但与病毒检测几率无关（所有 p < 0.05）。结论细菌或病毒的检测与 ABOS 的支气管扩张严重程度或临床结果有关。这凸显了综合痰微生物评估对确定主要病理生理学（特异性与感染）和纵向预测 ABOS 病变轨迹的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Translational Allergy Immunology and Microbiology-Immunology

CiteScore

7.50

自引率

4.50%

发文量

117

审稿时长

12 weeks

期刊介绍： Clinical and Translational Allergy, one of several journals in the portfolio of the European Academy of Allergy and Clinical Immunology, provides a platform for the dissemination of allergy research and reviews, as well as EAACI position papers, task force reports and guidelines, amongst an international scientific audience. Clinical and Translational Allergy accepts clinical and translational research in the following areas and other related topics: asthma, rhinitis, rhinosinusitis, drug hypersensitivity, allergic conjunctivitis, allergic skin diseases, atopic eczema, urticaria, angioedema, venom hypersensitivity, anaphylaxis, food allergy, immunotherapy, immune modulators and biologics, animal models of allergic disease, immune mechanisms, or any other topic related to allergic disease.