[Analysis of bronchiectasis in hospitalized asthmatic patients: 10-year experience of a single center].

Objective: To analyze bronchiectasis in hospitalized asthmatic patients in the past 10 years in a single center. Methods: The clinical data of all asthmatic patients, who were hospitalized in the Center of Respiratory Medicine and Allergic Diseases, the General Hospital of Northern Military District from January 1, 2008 to December 31, 2017, was retrospectively collected and analyzed. The data of hospitalized asthmatic patients, hospitalized asthmatic patients with bronchiectasis and hospitalized asthmatic patients with acute exacerbation of bronchiectasis in the past 10 years and the trends of 10 consecutive years were analyzed. According to whether or not co-existing with bronchiectasis, asthmatic patients were divided into asthmatic patients with bronchiectasis group and asthmatic patients without bronchiectasis group, then the general condition, symptoms, characteristics and comorbidities of the two groups were analyzed and the risk factors of bronchiectasis in asthmatic patients were also analyzed. According to the number of hospitalizations, asthmatic patients with bronchiectasis group was divided into hospitalization ≥ 2 times group and single-time group; according to the causes of hospitalization, asthmatic patients with bronchiectasis group was divided into asthmatic patients hospitalized for acute exacerbation of bronchiectasis group, hospitalized for acute asthmatic attack group and hospitalized for acute exacerbation of other comorbidities group. Then the reasons for different hospitalization times and the clinical characteristics, comorbidities and risk factors of asthmatic patients hospitalized for acute exacerbation of bronchiectasis group were analyzed. Results: A total of 2 207 cases of hospitalized asthmatic patients were included, of which 434 cases (19.7%) were classified into asthmatic patients with bronchiectasis group over the 10-year study period. The lowest percentage of asthmatic patients with bronchiectasis group over the total hospitalized asthmatic patients was observed in the year 2008 (8.2%, 17/207), and there was significant difference in the comparison of the 2008 and 2011 through 2017 (all P<0.05). The most common risk factor of asthmatic patients with bronchiectasis group was hemoptysis, followed by wet rales on physical examination, phlegm, cough, shortness of breath after activity, T>37 ℃, co-existing with emphysema, hospitalization≥ 14 d (OR=13.75, 2.638, 2.156, 1.957, 1.828, 1.351, 1.383, 1.351). In asthmatic patients with bronchiectasis group, there were 181 cases (41.7%) in ≥2 times group, 253 cases (58.3%) in single-time group; when the reason for hospitalization was analyzed by grouping single-time versus ≥2 times, the reason of acute asthmatic attack: the number of cases in ≥2 times group (45.9%, 83/181) was similar to the single-time group (46.2%, 117/253); the reason of acute exacerbation of bronchiectasis: the number of cases in ≥2 time groups (47.0%, 85/181) was higher than the single-time group (40.3%, 102/253); but there was no significant difference between the two groups (P>0.05). The reason of acute exacerbation of other comorbidities: the number of cases in ≥2 times group was significantly lower than single-time group [13 cases (7.2%) vs 34 cases (13.4%), P<0.05]. The frequencies of symptoms of fever, cough, phlegm, hemoptysis, shortness of breath after activity, wet rales on physical examination, hospitalization ≥ 14 d, non-invasive mechanical ventilation, co-existing with emphysema, heart function insufficiency and cor pulmonale in asthmatic patients hospitalized for acute exacerbation of bronchiectasis group was higher than hospitalized for acute asthmatic attack group (all P<0.05). Hospital costs in asthmatic patients with bronchiectasis group was higher than asthmatic patients without bronchiectasis group [RMB 11 264 (8 035, 17 161) vs 9 337 (5 916, 15 151) yuan]; asthmatic patients hospitalized for acute exacerbation of bronchiectasis group was higher than hospitalized for acute asthmatic attack group [RMB 13 101 (8 931, 20 118) vs 10 076 (7 136, 14 659) yuan] (both P<0.05). Conclusions: Asthmatic patients with bronchiectasis have an increased trend of hospitalization. In asthmatic patients hospitalized for acute exacerbation of bronchiectasis, the symptoms of fever, hemoptysis, cough and sputum were more frequently seen than those in asthmatic patients hospitalized for acute asthmatic attack, and the former have more serious condition, longer hospitalization and increased costs.