Predicting outcomes in bronchiectasis

Bronchiectasis is a common chronic respiratory disorder characterized by irreversible bronchial dilatation leading to daily productive cough and recurrent respiratory infections. This is a simplistic description of a multidimensional disease with heterogeneous clinical course and significant co-morbidity. According to expert opinion, along with vast evidence in other chronic diseases [e.g. chronic obstructive pulmonary disease (COPD) and asthma], accurate severity assessment is essential to guide decisionmaking treatment and disease management. Historically evaluated based on computed tomography (CT) features, bronchiectasis severity assessment has been increasingly recognized as an integration of many clinical, functional, radiological and microbiological factors. In the last few years, two multidimensional scoring systems, the Bronchiectasis Severity Index (BSI) and FACED have been developed to integrate those fundamental factors predicting prognosis of patients with bronchiectasis. BSI was derived from a prospective cohort including 608 patients from United Kingdom (UK) and externally validated in independent cohorts from UK (n = 344), Belgium (n = 253) and Italy (n = 105). FACED was developed using data from a retrospective cohort of 819 patients from Spain. Both scores comprise similar variables like age, Medical Research Council (MRC) dyspnoea score, forced expiratory volume in first second (FEV1) % predicted, Pseudomonas aeruginosa chronic infection and radiological severity. The major difference is that BSI also incorporates body mass index (BMI), hospitalizations in the past 2 years, exacerbations in the past 12 months, and chronic infection with bacteria other than P. aeruginosa (Tables 1 and 2). BSI awards different point values for each variable and FACED uses dichotomized variables with distinct cut-off points. Both scores classify bronchiectasis as mild (BSI score 0--4, FACED score 0--2), moderate (BSI score 5--8, FACED score 3--4) or severe (BSI score ≥9, FACED score 5--7). The scores are shown in Table 1. Since their development, some studies have tried to compare and contrast the evaluation of disease severity and the prognostic value of these two scoring systems. In the last edition of the Pulmonology, Costa et al. explored this issue. They performed a retrospective study of 40 patients from Coimbra, Portugal to compare classification Table 1 The Bronchiectasis Severity Index.