Screening for primary immune deficiency among patients with bronchiectasis

Introduction

To assess frequency and methods of PID (primary immune deficiency) screening among patients with bronchiectasis by pneumologists in clinical practice.

Methods

All the patients hospitalized in the department of pneumology of the Poitiers University Hospital between April 2013 and April 2020 with a diagnosis of bronchiectasis on chest computerized tomography were included. Patients aged 70 and over and those with already known PID were excluded. Primary endpoint was the proportion of patients having had serum immunoglobulin (Ig) assay and serum protein electrophoresis (SPE) analysis. Secondary endpoints were factors associated with prescription of SPE and/or Ig assay, proportion of patients with newly diagnosed PID and their characteristics and factors associated with repeated courses of antibiotics.

Results

Among the 133 patients included, 43% had SPE + Ig assay, 34% SPE only and 23% neither. The proportion of patients with asthma was higher in the “SPE + Ig assay” group (33.3%) compared to the “SPE only” (11.1%) and the “Neither SPE nor Ig assay” groups (6.4%) (P = 0.002). Four patients were newly diagnosed for PID of whom 3 had subclass IgG deficiency. Factors associated with repeated courses of antibiotics were generalized bronchiectasis (P = 0.02) and asthma (P = 0.04).

Conclusion

PID is underscreened by pneumologists among patients with bronchiectasis. Association of SPE + Ig assay + IgG subclass assay appears as the most accurate combination.