Characteristics of Clinical, Laboratory and Instrumental Features of the Combination of Chronic Obstructive Pulmonary Disease GOLD III, Group E, in Remission, Gastroesophageal Reflux Disease and Secondary Bronchiectasis

Objective — to investigate the nature and severity of clinical, laboratory, and instrumental changes, as well as quality of life of life in patients, depending on the type of inflammatory response and the presence of secondary bronchiectasis in the combination of COPD and GERD. Materials and methods. 130 patients in the remission phase of COPD GOLD 3, group E, were examined using clinical, laboratory, and instrumental methods. Based on the obtained data, the course of the combined pathology was characterised. Patients were divided into groups and subgroups depending on confirmed diag­noses and the type of inflammatory response: Group 1 — 68 patients with COPD (subgroup 1a (n = 44) — neutrophilic inflammation, subgroup 1b (n = 8) — neutrophilic inflammation with secondary bronchiectasis, subgroup 1c (n = 16) — eosinophilic inflammation), Group 2 — 62 patients with COPD combined with GERD (subgroup 2a (n = 34) — neutrophilic inflammation, subgroup 2b (n = 25) — neutrophilic inflammation with secondary bronchiectasis, subgroup 2c (n = 3) — eosinophilic inflammation). The control group consisted of 15 practically healthy individuals. Results and discussion. The gender distribution is characterized by a more frequent occurrence of COPD in men — 75 (57.7 %) compared to women — 55 (42.3 %). The most common subjective symptom was shortness of breath, with the highest percentage (72.0 %) recorded in patients with COPD (neutrophilic inflammation) combined with gastroesophageal reflux disease (GERD) and bronchiectasis (BE), and they also more often experienced a wet cough (88.0 %). A statistically significant difference in the frequency of dry cough was observed between subgroups 1a and 2a (22.7 vs. 58.8 %; p = 0.002). The nature of the inflammatory process showed a statistically significant increase in the proportion of neutrophilic inflammation in the group of patients with combined COPD + GERD pathology (76.5—95.2 %; p = 0.0027). The frequency of secondary BE in the COPD + GERD group was 3.1 times higher (25 cases vs. 8). Patients with COPD GOLD III, group E, in remission demonstrated pronounced impairments in pulmonary function compared to PHI, which is manifested by a significant decrease in PFT indicators (p < 0.001). Differences in quality of life (QoL) between different groups of patients with COPD, COPD + GERD, and COPD + GERD + BE directly depended on the presence of polymorbidity and worsened with its increase. Conclusions. The results obtained regarding the features of clinical symptoms, changes in pulmonary function, QoL in the examined individuals with COPD GOLD III, group E, depended on the presence of combined pathology and were prognostically more severe with the simultaneous coexistence of several nosologies.