Background

In COPD, coexistent bronchiectasis is associated with a poorer prognosis. However, the prognostic value of bronchiectasis in at-risk smokers without spirometric COPD and those with preserved ratio and impaired spirometry (PRISm) is not well known.
 
Aims

To determine the association of bronchiectasis and mortality in at-risk smokers and those with PRISm and COPD.
 
Methods

In 8,088 current and former smokers 45-80 years old from the COPDGene cohort, bronchiectasis was identified on CT scans using an airway-to-artery diameter ratio (AAR) >1 quantified with a validated artificial intelligence-based tool (Radiology 2022;221109). We defined bronchiectasis as >1% of bronchi with AAR>1 plus ?2 of the following: cough, phlegm, dyspnea, and history of ?2 exacerbations. The association of bronchiectasis and all-cause mortality was assessed with multivariable Cox models.
 
Results

During a median follow-up of 10.7 years, mortality rates were 13%, 22%, and 40% in the at-risk (n = 3523), PRISm (n = 1052), and COPD (n = 3513) groups, respectively (Figure). In adjusted models, bronchiectasis was associated with an increased risk of all-cause mortality (at-risk smokers, hazard ratio [HR] [95%CI] 1.75 [1.34?2.30]; PRISm, HR 1.31 [0.91?1.90]; COPD, HR 1.25 [1.10?1.41]).

Conclusion

 
Bronchiectasis portends a greater death risk in at-risk smokers, even higher than in smokers with COPD.