P225 Bronchiectasis is associated with a higher risk for infective exacerbations in patients with chronic hypercapnic COPD receiving long-term non-invasive ventilation

Le résumé fourni par la source

Introduction Patients with chronic obstructive pulmonary disease (COPD) and chronic hypercapnia are at a higher risk of acute exacerbations (AEs) compared to those without hypercapnia. Long-term non-invasive ventilation (LT-NIV) can reduce this risk, but its effectiveness may be diminished in patients with coexisting bronchiectasis. It remains unclear whether bronchiectasis independently increases the risk of AEs in patients with chronic hypercapnic COPD receiving LT-NIV. Methods We retrospectively identified 335 patients with chronic hypercapnic COPD who were initiated on LT-NIV at our tertiary ventilation centre between September 2011 and September 2023, with follow-up continuing until January 2025. Bronchiectasis was diagnosed based on chest CT findings, and severity was quantified using the Bronchiectasis Severity Index (BSI) and the FACED score. Clinical data at LT-NIV initiation and during follow-up were analysed and compared between patients with and without bronchiectasis. A Cox-regression analysis was conducted to evaluate the impact of bronchiectasis on AEs. Results The median follow-up time was 26 months. Ninety-five patients (28.4%) were diagnosed with bronchiectasis. Prior to LT-NIV initiation, patients with bronchiectasis experienced more exacerbations than those without (median (IQR): 4 (2–4) vs. 3 (2–5); p=0.02). However, bronchiectasis was not associated with exacerbation-free survival after LT-NIV initiation (p=0.24). Notably, patients with bronchiectasis had significantly shorter infective exacerbation-free survival (p=0.04). A higher BSI score prior to LT-NIV initiation was significantly correlated with increased total exacerbations (ρ=0.51, p<0.01) and infective exacerbations (ρ=0.34, p<0.01), but not with exacerbation-free survival after LT-NIV initiation (both p>0.05). The FACED score showed no correlation with exacerbations before or after LT-NIV initiation. Conclusion Coexisting Bronchiectasis increases the risk of infective exacerbations in patients with chronic hypercapnic COPD receiving LT-NIV. This highlights the importance of actively screening for and managing bronchiectasis in this patient population.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.