Chest
Volume 142, Issue 1, July 2012, Pages 159-167
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Original Research
Bronchiectasis
Bronchiectasis in a Diverse US Population: Effects of Ethnicity on Etiology and Sputum Culture

https://doi.org/10.1378/chest.11-1024Get rights and content

Background

Previous studies of patients with bronchiectasis have found that the cause is idiopathic in the majority of cases, but these studies were done in homogeneous populations. We hypothesized that the etiology of bronchiectasis can be determined in a higher percentage of patients in a diverse US population and will differ significantly based on ethnicity.

Methods

One hundred twelve patients with bronchiectasis confirmed by chest CT scan entered the study. Data from 106 patients were available for full evaluation. Clinical questionnaire, pulmonary function tests, sputum microbiology, laboratory data, and immune function testing were done. Results were analyzed by ethnicity and etiology.

Results

Patients were 61.6% European American (EA), 26.8% African American (AA), 8.9% Hispanic American (HA), and 2.7% Asian American. A cause of bronchiectasis was determined in 93.3% of patients. In 63.2% of patients, bronchiectasis was caused by immune dysregulation, including deficiency (n = 18 [17%]), autoimmune disease (n = 33 [31.1%]), hematologic malignancy (n = 15 [14.2%]), and allergic bronchopulmonary aspergillosis (n = 1 [0.9%]). Rheumatoid arthritis was the cause of bronchiectasis in 28.6% of AA patients vs 6.2% of EA patients (P < .05). Hematologic malignancy was the etiology in 20.0% of the EA patients vs none of the AA patients (P = .02). A significantly higher percentage of HA patients had Pseudomonas aeruginosa in their sputum compared with AA and EA patients (P = .01).

Conclusions

The etiology of bronchiectasis can be determined in the majority of patients in a heterogeneous US population and is most often due to immune dysregulation. Rheumatoid arthritis is more likely in AA patients than EA patients. HA patients are more likely to have P aeruginosa in their sputum.

Section snippets

Study Population

Approval for this study was obtained by the internal review board of the University of Chicago (09-069-B), and all patients provided informed consent. Patients with bronchiectasis were initially identified by International Classification of Diseases, Ninth Edition code or by referral. Patients with cystic fibrosis (CF), emphysema, and interstitial lung disease were excluded.

Clinical Assessment

A clinical questionnaire was administered to each patient, assessing demographics and medications, tobacco and alcohol

Results

HRCT scanning confirmed the presence of bronchiectasis in 114 patients. Two patients declined consent, yielding 112 patients for the initial evaluation. Six patients did not follow up with the evaluation; thus, 106 patients were available for the complete analysis (Fig 1).

Discussion

We describe the etiology of bronchiectasis in 106 patients in a diverse US population. Consistent with previous studies,20 the present population was predominantly women and nonsmokers. Prior investigations into the etiology of bronchiectasis have found that between 26% and 53% of cases are idiopathic.8, 9 In contrast, only 6.6% of the present cases were idiopathic after systematic evaluation. The study population was ethnically diverse, with 40% of non-EA ethnicity. Given the influence of

Acknowledgments

Author contributions: Dr McShane had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr McShane: contributed to data collection, organization, and analysis and to the preparation, writing, review, and submission of the manuscript.

Dr Naureckas: contributed to data collection, organization, and analysis and to the preparation, writing, review, and submission of the manuscript.

Dr Strek: contributed to data

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    Drs Naureckas and Strek contributed equally to this work.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

    Funding/Support: The authors have reported to CHEST that no funding was received for this article.

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