Validating the ROSE criteria for COPD-Bronchiectasis coexistence in East Asian populations: Data from Taiwan Bronchiectasis Research Collaboration (TBARC)

<bold>Introduction:</bold> The Radiology, Obstruction, Symptoms, and Exposure (ROSE) criteria, recently established for defining the "COPD-bronchiectasis (BE) association," facilitate the objective validation of patients with coexisting COPD and bronchiectasis. <bold>Aim:</bold> This study evaluates the clinical impact and outcomes of ROSE-defined COPD-BE in East Asian bronchiectasis patients. <bold>Methods:</bold> A prospective single-center cohort (n=147) and a retrospective multicenter study (n=574) of Taiwan Bronchiectasis Research Collaboration(TABARC) serve as validating cohorts to assess the effectiveness of the ROSE criteria in identifying COPD-BE association (Figure). <bold>Results:</bold> In the prospective validation cohort, 21.7% (n=32) and in the retrospective cohort, 15% (n=86) of patients with a COPD-BE association were predominantly male and older, exhibited higher dyspnea scores, had increased clinical diagnoses of COPD, and used more inhalation therapy compared to those without fixed airflow obstruction (FAO). The log-rank test from the prospective study indicated that patients with COPD-BE and nonsmoking BE with FAO had a significantly higher risk of exacerbations (p=0.024). Adjusted analyses confirmed an independently increased risk of exacerbations associated with COPD-BE (HR: 2.57, 95% CI: 1.025-6.484, p=0.044), a finding consistent across the retrospective cohort (aOR: 2.27, 95% CI: 1.11-4.63). <bold>Conclusion:</bold> The ROSE criteria effectively identify patients with the COPD-BE association in East Asian cohorts, indicating a high risk of exacerbation.