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Bronchiectasis (BE) might be frequently present in COPD but masked by COPD symptoms. We studied the relationship of clinical signs of bronchiectasis to the presence and extent of its radiological signs in patients of different COPD severity. Visit 4 data (GOLD grades 1-4) of the COSYCONET cohort was used. Chest CT scans were evaluated for bronchiectasis in 6 lobes using a 3-point scale (0: absence, 1: ≤50%, 2: >50% BE-involvement for each lobe). 1176 patients were included (61%male, age 67.3y), among them 38 (3.2%) with reported physicians' diagnosis of bronchiectasis and 76 (6.5%) with alpha1-antitrypsin deficiency (AA1D). CT scans were obtained in 429 patients. Within this group, any signs of bronchiectasis were found in 46.6% of patients, whereby ≤50% BE occurred in 18.6% in ≤2 lobes, in 10.0% in 3-4 lobes, in 15.9% in 5-6 lobes; >50% bronchiectasis in at least 1 lobe was observed in 2.1%. Scores ≥4 correlated with an elevated ratio FRC/RV. The clinical diagnosis of bronchiectasis correlated with phlegm and cough and with radiological scores of at least 3, optimally ≥5. In COPD patients, clinical diagnosis and radiological signs of BE showed only weak correlations. Correlations became significant with increasing BE-severity implying radiological alterations in several lobes. This indicates the importance of reporting both presence and extent of bronchiectasis on CT. Further research is warranted to refine the criteria for CT scoring of bronchiectasis and to determine the relevance of radiologically but not clinically detectible bronchiectasis and their possible implications for therapy in COPD patients.

The COPD Assessment Test (CAT) is in widespread use for the evaluation of patients with chronic obstructive pulmonary disease (COPD). We assessed whether the CAT items carry additional information beyond the sum score regarding COPD characteristics including emphysema. Patients of GOLD grades 1 to 4 from the COPD cohort COSYCONET (German COPD and Systemic Consequences - Comorbidities Network) with complete CAT data were included (n = 2270), of whom 493 had chest CT evaluated for the presence of emphysema. Comorbidities and lung function were assessed following standardised procedures. Cross-sectional data analysis was based on multiple regression analysis of the single CAT items against a panel of comorbidities, lung function, or CT characteristics (qualitative score, 15th percentile of mean lung density), with age, BMI and gender as covariates. This was supported by exploratory factor analysis. Regarding the relationship to comorbidities and emphysema, there were marked differences between CAT items, especially items 1 and 2 versus 3 to 8. This grouping was basically confirmed by factor analysis. Items 4 and 5, and to a lower degree 1, 2 and 6, appeared to be informative regarding the presence of emphysema, whereas the total score was not or less informative. Regarding comorbidities, similar findings as for the total CAT score were obtained for the modified Medical Research Council scale (mMRC) which was also informative regarding emphysema. Our findings suggest that the usefulness of the CAT can be increased if evaluated on the basis of single items which may be indicating the presence of comorbidities and emphysema.

Background: Patients with interstitial lung diseases (ILD) are a heterogeneous group of individuals with a high burden of disease. Little is known about health care service provision and utilisation for ILD patients in Germany. Aims and objectives: Assessment to what extent the German health care service is used by ILD Patients. Methods: Data were obtained in a retrospective survey in a tertiary care centre for ILDs. Questionnaires on utilization of health care services were used. Considered health care was in- and outpatient treatment by general practioners and specialists, participation in rehabilitation programmes, ambulatory lung sports groups and ILD support groups. Share of individuals using the distinct service was the primary and volume of selected service utilisation was the secondary outcome parameter. Results: 109 ILD patients were included (62.4% male, mean age 66.9 years). Most common diagnoses were IPF (51.4%) and chronic HP (12.8%). In a median follow up interval of 5.0 months 41.3% visited at least once a general practitioner (mean number of visits 0.8, sd 1.2), 37.6% a respiratory physician (0.6, sd 1.0) and 10.1% another specialist due to their lung disease. All-cause hospitalisations were reported in 19.3% cases, 7.3% participated in inpatient rehabilitation programmes, 22.9% in lung sports groups and 6.4% in support groups. Conclusion: There seems to be a high demand on health care services by patients diagnosed with ILD, although to a varying range for individual factors which need to be analysed in further studies. This will help to optimise disease management and to influence the course of disease.A comparison with healthy controls will provide a basis for ongoing economic evaluation.