BRONCHIECTASIS - AN ORPHAN DISEASE WITH A POORLY-UNDERSTOOD PROGNOSIS

The prognosis and risk factors for bronchiectasis are at present poorl y known. The aim of this study was to examine the long-term prognosis and cause of death in this disease. The National Hospital Discharge Re gister was used to search for patients aged 35-74 yrs, with newly-diag nosed bronchiectasis in the period 1982-1986. Each of the 842 patients identified was matched with an asthmatic patient and a patient with c hronic obstructive pulmonary disease (COPD), who were of the same age and sex and who had been treated in hospital at the same time, The use of hospital services by these subjects was examined up to the end of 1992, and mortality to the end of 1993. The prognosis for the bronchie ctatic patients treated in hospital was better than that for the COPD patients but poorer than that for the asthmatics; the risk of death be ing 1.25 (95% confidence interval (95% CI) 1.15-1.36) for the CORD pat ients and 0.79 (95% CI 0.71-0.87) for the asthmatics, relative to the bronchiectatic patients, Bronchiectasis was the main cause of death in 13% of bronchiectatic patients, the risk of death being increased by a factor of 1.21 in the presence of asthma as the main secondary diagn osis, by 1.31 with COPD, by 1.35 with tuberculosis and its sequelae, a nd by 1.32 with some other secondary diagnosis, as compared with cases for which no secondary diagnosis was indicated; The fact that the pro gnosis for bronchiectatic patients is poorer than that for asthmatics points to a continued need for focused care and follow-up, particularl y in the presence of additional illnesses.