Characteristics of bronchiectasis in Korea: First data from the Korean Multicentre Bronchiectasis Audit and Research Collaboration registry and comparison with other international registries

RespirologyVolume 26, Issue 6 p. 619-621 Forum and DebateFree Access Characteristics of bronchiectasis in Korea: First data from the Korean Multicentre Bronchiectasis Audit and Research Collaboration registry and comparison with other international registries Hyun Lee, Hyun Lee orcid.org/0000-0002-1269-0913 Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University Hospital, Seoul, South Korea Contribution: Conceptualization, Data curation, Formal analysis, ​Investigation, Writing - original draft, Writing - review & editingSearch for more papers by this authorHayoung Choi, Hayoung Choi Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea Contribution: Conceptualization, Data curation, Formal analysis, ​Investigation, Writing - original draft, Writing - review & editingSearch for more papers by this authorJames D. Chalmers, James D. Chalmers orcid.org/0000-0001-5514-7868 Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK Contribution: Conceptualization, ​Investigation, MethodologySearch for more papers by this authorRaja Dhar, Raja Dhar orcid.org/0000-0002-6742-5674 Department of Pulmonology, Interventions and Sleep Medicine, C K Birla group of Hospitals, Kolkata, India Contribution: Conceptualization, ​Investigation, Methodology, Writing - original draft, Writing - review & editingSearch for more papers by this authorTu Q. Nguyen, Tu Q. Nguyen Lung Foundation Australia, Milton, QLD, Australia Contribution: Data curation, Formal analysis, Writing - original draft, Writing - review & editingSearch for more papers by this authorSimone K. Visser, Simone K. Visser Department of Respiratory Medicine, Royal Prince Alfred Hospital, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia Contribution: Formal analysis, Writing - original draft, Writing - review & editingSearch for more papers by this authorLucy C. Morgan, Lucy C. Morgan Department of Respiratory Medicine, Concord Repatriation General Hospital; University of Sydney, Concord Clinical School, Faculty of Medicine and Health, Concord, New South Wales, Australia Contribution: Conceptualization, ​Investigation, Methodology, Writing - original draft, Writing - review & editingSearch for more papers by this authorYeon-Mok Oh, Corresponding Author Yeon-Mok Oh ymoh55@amc.seoul.kr yeonmok.oh@gmail.com orcid.org/0000-0003-0116-4683 Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea Correspondence Yeon-Mok Oh, Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. Email: ymoh55@amc.seoul.kr, yeonmok.oh@gmail.com Contribution: Conceptualization, ​Investigation, Methodology, Supervision, Writing - original draft, Writing - review & editingSearch for more papers by this author Hyun Lee, Hyun Lee orcid.org/0000-0002-1269-0913 Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University Hospital, Seoul, South Korea Contribution: Conceptualization, Data curation, Formal analysis, ​Investigation, Writing - original draft, Writing - review & editingSearch for more papers by this authorHayoung Choi, Hayoung Choi Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea Contribution: Conceptualization, Data curation, Formal analysis, ​Investigation, Writing - original draft, Writing - review & editingSearch for more papers by this authorJames D. Chalmers, James D. Chalmers orcid.org/0000-0001-5514-7868 Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK Contribution: Conceptualization, ​Investigation, MethodologySearch for more papers by this authorRaja Dhar, Raja Dhar orcid.org/0000-0002-6742-5674 Department of Pulmonology, Interventions and Sleep Medicine, C K Birla group of Hospitals, Kolkata, India Contribution: Conceptualization, ​Investigation, Methodology, Writing - original draft, Writing - review & editingSearch for more papers by this authorTu Q. Nguyen, Tu Q. Nguyen Lung Foundation Australia, Milton, QLD, Australia Contribution: Data curation, Formal analysis, Writing - original draft, Writing - review & editingSearch for more papers by this authorSimone K. Visser, Simone K. Visser Department of Respiratory Medicine, Royal Prince Alfred Hospital, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia Contribution: Formal analysis, Writing - original draft, Writing - review & editingSearch for more papers by this authorLucy C. Morgan, Lucy C. Morgan Department of Respiratory Medicine, Concord Repatriation General Hospital; University of Sydney, Concord Clinical School, Faculty of Medicine and Health, Concord, New South Wales, Australia Contribution: Conceptualization, ​Investigation, Methodology, Writing - original draft, Writing - review & editingSearch for more papers by this authorYeon-Mok Oh, Corresponding Author Yeon-Mok Oh ymoh55@amc.seoul.kr yeonmok.oh@gmail.com orcid.org/0000-0003-0116-4683 Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea Correspondence Yeon-Mok Oh, Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. Email: ymoh55@amc.seoul.kr, yeonmok.oh@gmail.com Contribution: Conceptualization, ​Investigation, Methodology, Supervision, Writing - original draft, Writing - review & editingSearch for more papers by this author First published: 19 April 2021 https://doi.org/10.1111/resp.14059Citations: 3 Hyun Lee and Hayoung Choi contributed equally to this study. Handling Editors: Philip Bardin and Paul King AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat To the Editors: Understanding the aetiology and characteristics of patients with bronchiectasis is vital for developing strategies to reduce the burden of disease; however, geographical variations in these characteristics, which may have important implications for diagnosis and treatment,1, 2 make it difficult to formulate a uniform strategy for investigation. Here, we describe the burden of illness and treatment among Korean bronchiectasis patients and compare the results with those from three geographically and ethnically diverse regions: Australia, Europe and India. The Korean Multicentre Bronchiectasis Audit and Research Collaboration (KMBARC) is a prospective, non-interventional observational study.3 Data were collected from 598 patients enrolled in the KMBARC registry between August 2018 and December 2019. The KMBARC registry design and data collection fields are closely aligned with those used by other registries. Detailed information on bronchiectasis cohorts in Australia (n = 653), Europe (n = 2596) and India (n = 2195) has been previously described.1, 2, 4 Most patients in all cohorts were aged >60 years and predominantly females; however, Indian patients were nearly 10 years younger on average and predominantly males. The BMI was lower in Koreans and Indians than in Australians and Europeans. Regarding comorbidities, Korean patients showed a lower prevalence of ischaemic heart disease and a higher prevalence of chronic obstructive pulmonary disease than those in other bronchiectasis registries. The prevalence of asthma in Korean patients was comparable with that in Indians, but it was relatively lower in Australians and Europeans (Table 1). The bronchiectasis severity index of Koreans (median 6) was comparable with that of Europeans (median 6) and Indians (median 7). However, the bronchiectasis severity index of Australians (median 9) was relatively higher than that recorded in other registries. The rate of experiencing more than one hospital admission in the previous year was highest for Indians (38.8%), followed by Australians (30.5%), Europeans (25.9%) and Koreans (18.2%). Regarding pulmonary function, Australians had the highest forced expiratory volume in 1 s (% predicted) (median 79.4), followed by Europeans (median 73.8), Koreans (median 65.4) and Indians (median 61.4). Pseudomonas aeruginosa was the most common causative pathogen among Koreans, Australians and Indians, whereas Haemophilus influenzae was the most common in Europeans (Table 1). TABLE 1. Comparison of the clinical characteristics of bronchiectasis in cohorts from Korea, Australia, Europe and India Korea (n = 598) Australia (n = 653) Europeaa Data on Europe and India were cited with permission from Dhar et al.1 (n = 2596) Indiaaa Data on Europe and India were cited with permission from Dhar et al.1 (n = 2195) Demographics Age, years 66 (60–72) 73 (64–79) 67 (57–74) 56 (41–66) Men 264 (44.1) 195 (29.9) 1010 (38.9) 1249 (56.9) BMI, kg/m2 22.9 (20.7–25.4) 25.0 (21.5–29.0) 24.8 (21.8–28.1) 21.5 (18.5–24.5) Current or former smokers 211 (35.3) 145 (22.2) 990 (38.1) 619 (28.2) Comorbidities Ischaemic heart disease 27 (4.5) 46 (7.0) 453 (17.5) 355 (16.2) Stroke 11 (1.8) 20 (3.1) 152 (5.9) 9 (0.4) Diabetes mellitus 73 (12.2) 42 (6.4) 260 (10.0) 315 (14.4) Liver disease 13 (2.2) 5 (0.8) 41 (1.6) 18 (0.8) Chronic renal failure 12 (2.0) 12 (1.8) 154 (5.9) 26 (1.2) COPD 226 (37.8) 95 (14.5) 431 (16.6) 512 (23.3) Asthma 134 (22.4) 94 (14.4) 226 (8.7) 485 (22.1) Osteoporosis 70 (11.7) 151 (23.1) 192 (7.4) 130 (5.9) GORD 89 (14.9) 224 (34.3) 394 (15.2) 346 (15.8) Solid tumour 50 (8.4) 14 (2.2) 164 (6.3) 17 (0.8) Disease severity BSI score 6 (4–9) 9 (6–12) 6 (4–10) 7 (3–10) BSI score risk class Mild 171 (29.4) 90 (17.9) 753 (29.0) 728 (33.2) Moderate 257 (44.1) 143 (28.5) 926 (35.7) 674 (30.7) Severe 154 (26.5) 269 (53.6) 917 (35.3) 793 (36.1) Radiological status Reiff score 5 (3–9) 4 (2–9) 4 (2–6) 6 (3–9) Clinical status mMRC dyspnoea scale 1 (1–1) 1 (0–2) 2 (1–3) 2 (1–3) Exacerbation in the previous year 1 (0–2) 1 (0–2) 2 (0–3) 1 (0–2) ≥1 Hospital admission in the previous year 109 (18.2) 199 (30.5) 672 (25.9) 851 (38.8) Functional status FEV1, % predicted 65.4 (52.0–78.7) 79.4 (61.0–96.5) 73.8 (54.0–92.1) 61.4 (41.9–80.5) Microbiology Pseudomonas aeruginosa 66 (11.0) 122 (18.7) 389 (15.0) 301 (13.7) Haemophilus influenzae 9 (1.5) 63 (9.7) 569 (21.9) 11 (0.5) Staphylococcus aureus 4 (0.7) 17 (2.6) 156 (6.0) 50 (2.3) Moraxella catarrhalis 3 (0.5) 14 (2.1) 154 (5.9) 22 (1.0) Enterobacteriaceae 23 (3.9) 12 (1.8) 158 (6.1) 215 (9.8) Aetiology of bronchiectasis (top five in orders) First Idiopathic (41%) Idiopathic (29%) Idiopathic (42%) TB (36%) Second TB (20%) Post-infective (27%) Post-infective (17%) Post-infective (22%) Third Post-infective (20%) NTM (7%) COPD (9%) Idiopathic (21%) Fourth Asthma (5%) PCD (4%) Asthma (6%) ABPA (9%) Fifth NTM (4%) ABPA (4%) Connective tissue diseases (6%) COPD (5%) Treatment Long-term antibiotics 23 (3.9) 205 (31.4) 503 (19.4) 271 (12.3) Inhaled antibiotics 0 27 (4.1) 166 (6.4) 79 (3.6) Note: Values in the table are median values (interquartile ranges) or numbers (%). Abbreviations: ABPA, allergic bronchopulmonary aspergillosis; BMI, body mass index; BSI, bronchiectasis severity index; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 s; GORD, gastro-oesophageal reflux disease; mMRC, modified Medical Research Council Dyspnoea; NTM, non-tuberculous mycobacteria; PCD, primary ciliary dyskinesia; TB, tuberculosis. a Data on Europe and India were cited with permission from Dhar et al.1 The two most common causes of bronchiectasis were idiopathic and tuberculosis (TB) in Koreans. In comparison, the two most common causes of bronchiectasis in the Australian and European registries were idiopathic and post-infective, whereas in the Indian registry, the most common causes were TB and post-infective. The rate of prescribing long-term antibiotics was highest in Australians (31.4%), followed by Europeans (19.4%), Indians (12.3%) and Koreans (3.9%) (Table 1). In conclusion, there were significant differences in the aetiology, comorbidities and treatment of bronchiectasis among the different countries and regions. Thus, we believe that the clinical guidelines for bronchiectasis in individual countries need to address these issues based on epidemiological data because they may vary from country to country. ACKNOWLEDGEMENTS The authors thank all members of the Australian (Australian Bronchiectasis Registry), European (EMBARC), Indian (EMBARC-India) and Korean (KMBARC) registries. AUTHOR CONTRIBUTIONS Hyun Lee: Conceptualization; data curation; formal analysis; investigation; writing-original draft; writing-review & editing. Hayoung Choi: Conceptualization; data curation; formal analysis; investigation; writing-original draft; writing-review & editing. James D Chalmers: Conceptualization; investigation; methodology. Raja Dhar: Conceptualization; investigation; methodology; writing-original draft; writing-review & editing. Tu Q Nguyen: Data curation; formal analysis; writing-original draft; writing-review & editing. Simone K Visser: Formal analysis; writing-original draft; writing-review & editing. Lucy C Morgan: Conceptualization; investigation; methodology; writing-original draft; writing-review & editing. Yeon-Mok Oh: Conceptualization; investigation; methodology; supervision; writing-original draft; writing-review & editing. CONFLICT OF INTEREST The authors acknowledge funding support to the Australian Bronchiectasis Registry provided by Insmed, Zambon and philanthropic donations. These sponsors had no input to the interpretation of data or preparation of the manuscript. The authors declare that they have no other conflicts of interest. REFERENCES 1Dhar R, Singh S, Talwar D, Mohan M, Tripathi SK, Swarnakar R, et al. Bronchiectasis in India: results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry. Lancet Glob Health. 2019; 7: e1269– e79. CrossrefPubMedWeb of Science®Google Scholar 2Visser SK, Bye PTP, Fox GJ, Burr LD, Chang AB, Holmes-Liew CL, et al. Australian adults with bronchiectasis: the first report from the Australian Bronchiectasis Registry. Respir Med. 2019; 155: 97– 103. CrossrefPubMedWeb of Science®Google Scholar 3Lee H, Choi H, Sim YS, Park S, Kim WJ, Yoo KH, et al. KMBARC registry: protocol for a multicentre observational cohort study on non-cystic fibrosis bronchiectasis in Korea. BMJ Open. 2020; 10:e034090. CrossrefPubMedWeb of Science®Google Scholar 4Araújo D, Shteinberg M, Aliberti S, Goeminne PC, Hill AT, Fardon TC, et al. The independent contribution of Pseudomonas aeruginosa infection to long-term clinical outcomes in bronchiectasis. Eur Respir J. 2018; 51:1701953. CrossrefPubMedWeb of Science®Google Scholar Citing Literature Volume26, Issue6June 2021Pages 619-621 ReferencesRelatedInformation