Etiology and Clinical Characteristics of a Non-Cystic Fibrosis Bronchiectasis Cohort in a Middle Eastern Population

Abstract Introduction: Bronchiectasis is a common airway disease characterized by airway dilatation and recurrent infections, leading to respiratory failure in severe cases. It is well known that the etiology of bronchiectasis varies geographically. However, there are no published data looking at the etiology of bronchiectasis within the middle eastern population. Methods: We performed a retrospective analysis of our bronchiectasis patient registry, recording the clinical and demographic characteristics from their electronic medical records. Quantitative variables are expressed as the median and interquartile range (IQR). Categorical variables are expressed as numbers and percentages. Statistical comparisons between continuous characteristics were carried out using the t-test, and a significant p-value was taken to be less than 0.05. Results: In total we analysed 260 records (63% female, 37% male), with median age of 58 years (interquartile range (IQR) 38–71), Body Mass Index (BMI) 25.8(IQR 22–30), forced expiratory volume in the first second (FEV1) %predicted 65 (IQR 43–79) and FEV1/forced vital capacity (FVC) 0.76 (0.67–0.86). Sixty-five cases (25%) were post-infectious in etiology (excluding post-TB – n:25 10.4%). Forty-eight (18.5%) patients were labelled idiopathic, while Primary Ciliary Dyskinesia (PCD) accounted for 23 (8.8%) cases. Pseudomonas aeruginosa was the most common colonizing organism (32.7%), followed by Haemophilus influenzae (9.2%) and Methicillin-Sensitive Staphylococcus aureus(6.9%). At the time of review, 11 patients had died (median age, FEV %predicted, and bronchiectasis severity index (BSI) 59 years, 38% and 15.5 respectively), all due to respiratory failure, and as expected, all were classed severe on BSI. The BSI score was available for 109 patients, of which 31(28%) were classed mild, 29(27%) were moderate, and 49 (45%) were classed severe. The median BSI score was 8 (IQR 4–11). On dividing the patients according to obstructive vs restrictive spirometry, we found that patients with FEV1/FVC < 0.70 had significantly higher BSI (10.1 vs 6.9, p-value < 0.001) and that 8 out of the 11 deceased patients had FEV1/FVC < 70%. Conclusions: In our cohort, post-infectious, idiopathic and the PCD were the most common aetiologies of bronchiectasis. Patients with obstructive spirometry seemed to have a worse prognosis than those with restriction.