Bronchiectasis is increasing in the UK, study showsBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5916 (Published 05 November 2015) Cite this as: BMJ 2015;351:h5916
The incidence and prevalence of bronchiectasis, a long term respiratory condition with persistent airway infection and recurrent exacerbations in people with structurally abnormal bronchi, has increased over the past decade and now affects more than 1% of people aged 70 and older, a UK study has shown.
The study, reported in the European Respiratory Journal, analysed anonymised primary care medical records for 14 million patients registered between 1 January 2004 and 31 December 2013.1 Researchers identified people aged 18 and over with a diagnosis of bronchiectasis and looked at trends in incidence, prevalence, and mortality over time.
They found that bronchiectasis was more common than the researchers had previously thought and was becoming even more common, particularly in older people.
Both the incidence and point prevalence of bronchiectasis increased each year over the study period. The incidence in women of all ages increased from 21.2 per 100 000 person years in 2004 to 35.2 per 100 000 person years in 2013, while the incidence in men increased from 18.2 to 26.9 per 100 000 person years. At the same time the point prevalence increased in women from 350.5 per 100 000 in 2004 to 566.1 per 100 000 in 2013, and from 301.2 to 485.5 per 100 000 in men.
The increase in incidence was particularly marked in people aged 70 or over, doubling from approximately 0.6% of people in this age group in 2004 to 1.2% in 2013.
The mortality in people with bronchiectasis was twice as high as that in the general population. In women, the age adjusted mortality rate for those with bronchiectasis was 1437.7 per 100 000 compared with 635.9 per 100 000 for the general population (comparative mortality 2.26). In men, the age adjusted mortality rates were 1914.6 and 895.2 per 100 000, respectively (comparative mortality 2.14).
“Bronchiectasis is historically associated with untreated chest infections when antibiotics were not readily available,” senior author Jeremy Brown, professor of respiratory infection at University College London said in a statement.
“We found that the disease has had a resurgence in recent years, particularly among more well-off members of society. This could be partly down to improved diagnosis in these groups, but whatever the reason we need better treatment options for patients,” he said, adding that similar increases in bronchiectasis had been seen in other industrialised countries.
The study found that 42% of people with bronchiectasis also had asthma and 36% had chronic obstructive pulmonary disease (COPD); 6.9% of people with bronchiectasis also had HIV, a much higher proportion than expected.
“The high prevalence of bronchiectasis in people with asthma and COPD is an important finding,” said lead author Jennifer Quint, who was at the London School of Hygiene and Tropical Medicine while carrying out the study but now works at Imperial College London. “Whether the diagnosis of bronchiectasis precedes or follows the diagnosis of asthma or COPD is important to investigate next as it may help to guide longer term management in these patients.”
Cite this as: BMJ 2015;351:h5916