Bronchiectasis is associated with a higher risk for acute exacerbations in patients with chronic hypercapnic COPD receiving long-term non-invasive ventilation

<bold>Introduction:</bold> Bronchiectasis may coexist with COPD and may contribute to the burden of acute exacerbations (AE). Patients with chronic hypercapnia have higher risk for AE. Reducing hypercapnia with long-term non-invasive ventilation (LT-NIV) may decrease the risk for AE; however, it is unclear if patients with co-existing bronchiectasis benefit from this intervention. <bold>Methods:</bold> 392 (age: 65±9 yrs, 41% male) patients with chronic hypercapnic COPD receiving LT-NIV were enrolled and followed up until the end of the data collection period or the death of the patient (median follow-up: 19 [IQR=9-42] months). Exacerbation history (moderate and severe), smoking history, presence of bronchiectasis, and capillary blood gas parameters were recorded at the time of enrolment and at follow-up visits. Time to the first AE following LT-NIV setup was collected and annualized AE rate during the follow-up was calculated to adjust for the different follow-up durations. <bold>Results:</bold> 38 (9.7%) patients had bronchiectasis. The median time to the first AE (2.0 [1.0-4.6] vs. 3.6 [1.4-11.0] months, p<0.02) and the follow-up AE rate (4.4 [2.2-6.6] vs. 1.9 [0.2-4.5] AE/year, p<0.01) differed significantly between patients with and without bronchiectasis. Bronchiectasis was associated with an elevated hazard ratio for AEs (HR=1.61, 95% CI (1.04-2.51), p=0.03) after adjusting for age, sex, baseline AE rate, smoking and therapy adherence. <bold>Conclusion:</bold> Bronchiectasis independently increases the risk of AEs in chronic hypercapnic COPD on LT-NIV; therefore, bronchiectasis needs to be actively screened and treated.