Co-existent COPD and bronchiectasis common in the Top End

Co-existent COPD and bronchiectasis is a common finding in adult Aboriginal Australians living in regional and remote NT communities. 

A five-year retrospective study identified 258 Aboriginal Australians living with COPD who also had a chest X-ray or CT which could assess the presence or absence of bronchiectasis. 

The study, published in the Internal Medicine Journal, found 31.8% of the patients with COPD also had bronchiectasis. 

While the mean FEV1 indicated moderate to severe airflow obstruction in the patients with and without bronchiectasis (39% v 43% respectively), hospital admissions were more common in patients with both conditions (2 v 1.5 per year). 

Patients with COPD and bronchiectasis also had a significantly lower BMI than patients with only COPD (22.56 v 24.73).  

There was a non-significant trend to patients with COPD experiencing more shortness of breath while patients with both conditions were more likely to have a productive cough. 

Other parameters such as smoking history, comorbidities, exacerbations or sputum culture results were not significantly different between the two groups. 

“Our findings would suggest that in this setting a significant smoking history associated with symptoms of predominant dyspnoea without frequent mucous hypersecretion (productive chronic cough) may be more consistent with a diagnosis of isolated COPD while the presence of frequent exacerbations and chronic productive cough should raise the suspicion of COPD with co-existent bronchiectasis,” the researchers said.

They added that the increasing availability of CT scanning facilities in smaller regional centres in the NT and in other parts of Australia should encourage early referral for definitive diagnosis of bronchiectasis when this was suspected. 

“While diagnosing bronchiectasis in the setting of COPD should be encouraged, the limited treatment options for this condition to prevent exacerbations and disease progression should be appreciated. Effective airway clearance and pulmonary rehabilitation remain a cornerstone of bronchiectasis management.”

They suggested the provision of a dedicated physiotherapy service focusing on airway clearance and pulmonary rehabilitation should be considered. 

There was also a “desperate need” for normative reference lung function values in the Aboriginal Australian population.

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