Journal Information
Vol. 46. Issue S3.
Las mil caras de la EPOC
Pages 11-17 (June 2010)
Share
Share
Download PDF
More article options
Vol. 46. Issue S3.
Las mil caras de la EPOC
Pages 11-17 (June 2010)
Full text access
EPOC y bronquiectasias
Chronic obstructive pulmonary disease and bronchiectasias
Visits
24881
Miguel Ángel Martínez García
Corresponding author
miangel@comv.es

Autor para correspondencia.
, Juan José Soler Cataluña
Unidad de Neumología, Hospital General de Requena, Valencia, España
This item has received
Article information
Abstract
Bibliography
Download PDF
Statistics
Resumen

La enfermedad pulmonar obstructiva crónica (EPOC) y las bronquiectasias son 2 de las enfermedades más frecuentes e infradiagnosticadas de la vía aérea. La relación existente entre ambas puede establecerse desde diferentes puntos de vista. Por una parte, su elevada prevalencia hace que no sea infrecuente observarlas de forma sincrónica en un mismo paciente. Por otra parte, estudios recientes han observado una asociación entre ambas, dado que más del 50% de los pacientes con EPOC moderada-grave presentan bronquiectasias no explicables por otras causas con la suficiente entidad como para provocar un exceso de inflamación bronquial y un aumento en el número de agudizaciones en estos pacientes, posiblemente mediado por un incremento en la colonización-infección bronquial por microorganismos potencialmente patógenos. Por último, y aunque hasta el momento no se ha demostrado, algunas hipótesis fisiopatológicas indican una relación de causalidad entre ambas enfermedades en la que la EPOC, especialmente las formas graves, sería un factor de riesgo para la formación de bronquiectasias.

Palabras clave:
Enfermedad pulmonar obstructiva crónica
Bronquiectasias
Agudización
Infección bronquial
Colonización bronquial
Microorganismos potencialmente patógenos
Pseudomonas aeruginosa
Abstract

Chronic obstructive pulmonary disease (COPD) and bronchiectasias are two of the most frequent and underdiagnosed diseases of the airways. The association between these two entities can be established from different points of view. On the one hand, because of their high prevalence, the co-occurrence of COPD and bronchiectasias in the same patient is not unusual. On the other hand, recent studies have observed an association between COPD and bronchiectasias, given that more than 50% of patients with moderate-severe COPD show bronchiectasias unexplained by other causes that could provoke an excess of bronchial inflammation, as well as a higher number of exacerbations, possibly mediated by an increase in bronchial colonization-infection by potentially pathogenic microorganisms. Lastly, some physiopathologic hypotheses that remain to be demonstrated suggest a causal relation between the two diseases in which COPD, especially severe forms, would constitute a risk factor for the formation of bronchiectasias.

Keywords:
Chronic obstructive pulmonary disease
Bronchiectasias
Exacerbation
Bronchial infection
Bronchial colonization
Potentially pathogenic microorganisms
Pseudomonas aeruginosa
Full text is only aviable in PDF
Bibliografía
[1.]
J.I. Estévez, M.A. Martínez-González, M. Seguí-Gómez.
Epidemiología aplicada.
Ariel Ciencias Médicas, (2004),
[2.]
V. Sobradillo, M. Miravitlles, C.A. Jiménez, R. Gabriel, J.L. Viejo, J.F. Masa, et al.
Estudio IBERPOC en España: prevalencia de síntomas respiratorios habituales y de limitación crónica al flujo aéreo.
Arch Bronconeumol, 35 (1999), pp. 159-166
[3.]
M. Miravitlles, J.B. Soriano, F. García-Río, L. Muñoz, E. Duran-Tauleria, G. Sanchez, et al.
Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities.
Thorax, 64 (2009), pp. 863-868
[4.]
M.A. Martínez-García.
Bronquiectasias: ¿todavía una enfermedad huérfana?.
Arch Bronconeumol, 41 (2005), pp. 407-409
[5.]
D. Weycker, J. Edelsberg, G. Oster.
Prevalence and economic burden of bronchiectasis.
Clin Pulm Med, 12 (2005), pp. 205-209
[6.]
M.B. Nicotra, M. Rivera, A.M. Dale, R. Shepherd, R. Carter.
Clinical, pathophysiologic, and microbiologic characterization of bronchiectasis in an aging cohort.
Chest, 108 (1995), pp. 955-961
[7.]
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. [Consultado 3/12/2009]. Disponible en: http://www.goldcopd.com/Guidelineitem.asp?11=2&l2=1∫Id=2003
[8.]
R.A. Stockley.
Neutrophils and the patogénesis of COPD.
Chest, 121 (2002), pp. 151s-155s
[9.]
S. Fuschillo, A. De Felice, G. Balzano.
Mucosal inflammation in idiopathic bronchiectasis: celllar and molecular mechanisms.
Eur Respir J, 31 (2008), pp. 396-406
[10.]
P.J. Cole.
Inflammation: a two-edged sword-the model of bronchiectasis.
Eur J Respir Dis Suppl, 147 (1986), pp. 6-15
[11.]
C.O. O’Brien, P.J. Guest, S.L. Hill, R.A. Stockley.
Physiological and radiological characterisation of patients diagnosed with chronic obstructive pulmonary disease in primary care.
Thorax, 55 (2000), pp. 635-642
[12.]
I.S. Patel, I. Vlahos, T.M.A. Wilkinson, S.J. Lloyd-Owen, G.C. Donaldson, M. Wilks, et al.
Bronchiectasis, exacerbations indices, and inflammation in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 170 (2004), pp. 400-407
[13.]
Y. Donat, M.A. Martínez-García, J.J. Soler-Cataluña, M. Perpiná-Tordera, P. Román-Sánchez.
Prevalencia de bronquiectasias y su impacto clínico-funcional en pacientes con enfermedad pulmonar obstructiva crónica moderado-grave.
Arch Bronconeumol, 44 (2008), pp. 60
[14.]
D. Bilton.
Update on non-cystic fibrosis bronchiectasis.
Curr Opin Pulm Med, 14 (2008), pp. 595-599
[15.]
A.E. O’Donnell.
Bronchiectasis.
Chest, 134 (2008), pp. 815-823
[16.]
D.P. Naidich, D.I. McCauley, N.F. Khouri, P.P. Stitik, S.S. Siegalman.
Computed tomography of bronchiectasis.
J Comput Assist Tomogr, 6 (1982), pp. 437-444
[17 .]
Olveira C, Doña E, De la Cruz JL. Diagnóstico por la imagen en las bronquiectasias. En: Martínez-García MA. Bronquiectasias no debidas a fibrosis quística. Neumología y Salud. SL ed; 2008.
[18.]
R. O’Donnell, D. Breen, S. Wilson, R. Djukanovic.
Inflammatory cells in the airways in COPD.
Thorax, 61 (2006), pp. 448-454
[19.]
L. Zheng, G. Tipoe, W.K. Lam, J.C. Ho, I. Shum, G.C. Ooi, et al.
Endothelin-1 in stable bronchiectasis.
Eur Respir J, 16 (2000), pp. 146-149
[20.]
S.C. Chan, D.K. Shum, M.S. Ip.
Sputum sol neutrophils elastase activity in bronchiectasis: differential modulation by syndecam-1.
Am Respir J Crit Care Med, 168 (2003), pp. 192-198
[21.]
J. Angrill, C. Agusti, R. De Celis, X. Filella, A. Raño, M. Elena, et al.
Bronchial inflammation and colonization in patients with clinically stable bronchiectasis.
Am J Respir Crit Care Med, 164 (2001), pp. 1628-1632
[22.]
J. Angrill, C. Agusti, R. De Celis, A. Ramo, J. Gonzalez, T. Sollé, et al.
Bacterial colonisation in patients with bronchiectasis: microbiological pattern and risk factors.
Thorax, 57 (2002), pp. 15-19
[23.]
R. Zalacaín, V. Sobradillo, J. Amilibia, J. Barrón, V. Achótegui, J.I. Pijoan, et al.
Predisposing factors to bacterial colonization in chronic obstructive pulmonary disease.
Eur Respir J, 13 (1999), pp. 343-348
[24.]
E. Monsó, A. Rosell, G. Bonet, J. Manterola, P.J. Cardona, J. Ruiz, et al.
Risk factors for lower airway bacterial colonization in chronic bronchitis.
Eur Respir J, 13 (1999), pp. 338-342
[25.]
N. Soler, S. Ewig, A. Torres, X. Filella, J. González, A. Xaubet.
Airway inflammation and bronchial microbial patterns in patients with stable chronic obstructive pulmonary disease.
Eur Respir J, 14 (1999), pp. 1015-1022
[26.]
J.R. Lapa e Silva, J.A.H. Jones, P.J. Cole, L.W. Poulter.
The immunological component of the cellular inflammatory infiltrate in bronchiectasis.
Thorax, 44 (1989), pp. 668-673
[27.]
M. Gaga, A.M. Bentley, M. Humbert, J. Barkans, F. O’Brien, C.G. Wathen, et al.
Increases in CD4 + T lymphocytes, macrophages, neutrophils and interleukin 8 positive cells in the airways of patients with bronchiectasis.
Thorax, 53 (1998), pp. 685-691
[28.]
M.B. Murphy, D.J. Reen, M.X. Fitzgerald.
Atopy, inmunological changes, and respiratory function in bronchiectasis.
Thorax, 39 (1984), pp. 179-184
[29.]
R. Cantón, N. Cobos, J. De Gracia, F. Baquero, J. Honorato, S. Gartner, et al.
Tratamiento antimicrobiano frente a la colonización pulmonar por Pseudomonas aeruginosa en el paciente con fibrosis quística.
Arch Bronconeumol, 41 (2005), pp. 1-25
[30.]
M. Woodhead, F. Blasi, S. Ewig, G. Huchon, M. Leven, A. Ortqvist, et al.
European Respiratory Society; European Society of Clinical Microbiology and Infectious Diseases. Guidelines for the management of adult lower respiratory tract infections.
Eur Respir J, 26 (2005), pp. 1138-1180
[31.]
M.A. Martínez-García, M. Perpiñá-Tordera, P. Román-Sánchez, J.B. Soriano.
Factors associated with lung function decline in patients with non-cystic fibrosis bronchiectasis.
Chest, 132 (2007), pp. 1565-1572
[32.]
S.A. Evans, S.M. Turner, B.J. Bosch, C.C. Hardy, M.A. Woodhead.
Lung function in bronchiectasis: the influence of Pseudomonas aeruginosa.
Eur Respir J, 9 (1996), pp. 1601-1604
[33.]
G. Davies, A.U. Wells, S. Doffman, S. Watanabe, R. Wilson.
The effect of Pseudomonas aeruginosa on pulmonary function in patients with bronchiectasis.
Eur Respir J, 28 (2006), pp. 974-979
[34.]
M.A. Martínez-García, M. Perpiñá, P. Román, J.J. Soler.
Quality of life determinants in patients with clinically stable bronchiectasis.
Chest, 128 (2005), pp. 739-745
[35.]
K.A. Miszkiel, A.U. Wells, M.B. Rubens, P.J. Cole, D.M. Hansell.
Effects of airway infection by Pseudomonas aeruginosa: a computed tomography study.
Thorax, 52 (1997), pp. 260-264
[36.]
P.T. King, S.R. Holdsworth, N.J. Freezer, E. Villanueva, P.W. Colmes.
Microbiologic follow-up study in adult bronchiectasis.
Respir Med, 101 (2007), pp. 1633-1638
[37.]
M.R. Loebinger, A.U. Wells, D.M. Hansell, N. Chinyanganya, A. Devaraj, M. Meister, et al.
Mortality in bronchiectasis: a long-term study assessing the factors influencing survival.
Eur Respir J, 34 (2009), pp. 843-849
[38.]
A. Rosell, E. Monsó, N. Soler, F. Torres, J. Angrill, G. Riise, et al.
Microbiologic determinants of exacerbation in chronic obstructive pulmonary disease.
Arch Intern Med, 165 (2005), pp. 891-897
[39.]
T.F. Murphy, A.L. Brauer, K. Eschberger, P. Lobbins, L. Grove, X. Cai, et al.
Pseudomonas aeruginosa in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 177 (2008), pp. 853-860
[40.]
M. Miravitlles, C. Espinosa, E. Fernández-laso, J.A. Marts, J.A. Maldonado, M. Gallego.
Relationship between bactrial flora in sputum and functional impairment in patines with acute exacerbations of COPD.
Chest, 116 (1999), pp. 40-46
[41.]
S. Sethi, N. Evans, R.N. Brydon, J.B. Grant, T.F. Murphy.
New strains of bacterial and exacerbations of chronic obstructive pulmonary disease.
N Engl J Med, 347 (2002), pp. 465-471
[42.]
C. García-Vidal, P. Almagro, V. Romani, M. Rodríguez-Carballeira, E. Cuchi, L. Canales, et al.
Pseudomonas aeruginosa in patients hospitalised for COPD exacerbations: a prospective study.
Eur Respir J, 34 (2009), pp. 1072-1078
[43.]
J. Eller, A. Ede, T. Schaberg, M.S. Niederman, H. Mauch, H. Lode.
Infective exacerbations of chronic bronchitis.
Chest, 113 (1998), pp. 1542-1548
[44.]
N. Soler, A. Torres, S. Ewig, J. González, R. Celis, M. El-Ebiary, et al.
Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation.
Am J Respir Crit Care Med, 157 (1998), pp. 1498-1505
[45.]
H. Lode, M. Allewelt, S. Balk, A. De Roux, H. Mauch, M. Niederman, et al.
A prediction model for bacterial etiology in acute exacerbations of COPD.
Infection, 35 (2007), pp. 143-149
[46.]
T.F. Murphy.
Pseudomonas aeruginosa in adults with chronic obstructive pulmonary disease.
Curr Opin Pulm Med, 15 (2009), pp. 138-142
[47.]
A.T. Hill, E.J. Campbell, S.T. Hill, D.L. Bayley, R.A. Stockley.
Association between airway bacterial load and markers of airway inflammation in patients with stable chronic bronchitis.
Am J Med, 109 (2000), pp. 288-295
[48.]
M. Vendrell, J. De Gracia, C. Olveira, M.A. Martínez-García, R. Girón, L. Máiz, et al.
Normativa sobre el diagnóstico y tratamiento de las bronquiectasias.
Arch Bronconeumol, 44 (2008), pp. 629-640
[49.]
M.C. Pasteur, S.M. Helliwell, S.J. Houghton, S.C. Webb, J.E. Foweraker, R.A. Coulden, et al.
An investigation into causative factors in patients with bronchiectasis.
Am J Respir Crit Care Med, 162 (2000), pp. 1277-1284
[50.]
D.G. Parr, P.G. Guest, J.H. Reynolds, L.J. Dowson, R.A. Stockley.
Prevalence and impact of bronchiectasis in alpha 1-antitrypsin deficiency.
Am J Respir Crit Care Med, 176 (2007), pp. 1215-1221
[51.]
A. Cuvelier, J.F. Muir, M.F. Hellot, D. Benhamou, J.P. Martin, J. Bénichou, et al.
Distribution of alpha 1 antitrypsin alleles in patients with bronchiectasis.
Chest, 117 (2000), pp. 415-419
[52.]
J.J. Soler-Cataluña, M.A. Martínez-García, P. Román Sánchez, E. Salcedo, M. Navarro, R. Ochando.
Severe acute exacerbations and mortality in patients with obstructive pulmonary disease.
Thorax, 60 (2005), pp. 925-931
[53.]
G.C. Donaldson, T.A.R. Seemungal, A. Bhowmik, J.A. Wedzicha.
Relationship between exacerbation frequancy and lung function decline in chronic obstructive pulmonary disease.
Thorax, 57 (2002), pp. 847-852
[54.]
J. Vestbo, E. Prescott, P. Lange.
Association of chronic mucus hypersecretion with FEV1 decline and chronic obstructive pulmonary disease morbidity. Copenhagen City Heart Study Group.
Am J Respir Crit Care Med, 153 (1996), pp. 1530-1535
[55.]
E. Prescott, P. Lange, J. Vestbo.
Chronic mucus hypersecretion in COPD and death from pulmonary infection.
Eur Respir J, 8 (1995), pp. 1333-1338
[56.]
A. Bhowmik, T.A.R. Seemungal, R.J. Sapsford, J.A. Wedzicha.
Relation of sputum inflammatory markers to symptoms and lung function changes in COPD exacerbations.
Thorax, 55 (2000), pp. 114-120
[57.]
T.M.A. Wilkinson, I.S. Patel, M. Wilks, G.C. Donaldson, J.A. Wedzicha.
Airway bacterial load and FEV1 decline in patients with chronic obstructive pulmonary disease.
Am J Respire Crit Care Med, 167 (2003), pp. 1090-1095
[58.]
M. Miravitlles.
Exacerbations of chronic obstructive pulmonary disease: when are bacterial important?.
Eur Respir J, 20 (2002), pp. 9s-19s
[59.]
S. Sethi, J. Maloney, L. Grove, C. Wrona, C.S. Berenson.
Airway inflammation and bronchial bacterial colonization in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 173 (2006), pp. 991-998
[60.]
D. Banerjee, O.A. Khair, D. Honeybourne.
Impact of sputum bacteria on airway inflammation and health status in clinical stable COPD.
Eur Respir J, 23 (2004), pp. 685-691
[61.]
I.S. Patel, T.A.R. Seemungal, M. Wilks, S.J. Lloyd-Owen, G.C. Donaldson, J.A. Wedzicha.
Relationship between bacterial colonisation and the frequency, caracter, and severity of COPD exacerbations.
Thorax, 57 (2002), pp. 759-764
[62.]
E.A. Hoffman, B.A. Simon, G. McLennan.
A structural and functional assessment of the lung via multidetector-row computed tomography.
Proc Am Thorac Soc, 3 (2006), pp. 519-534
Copyright © 2010. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?