2005 A study on haemoptysis on patients with bronchiectasis
Dr. Clara SW Yan, Tuberculosis and Chest Unit, Grantham Hospital
Study objective
Haemoptysis is an important and alarming symptom commonly found in patients with bronchiectasis. However it does not occur invariably in all patients with the disease. The relationships between haemoptysis with clinical, physiological, radiological and bacteriological parameters have not been systematically studied previously. This study is designed to characterize the clinical, physiological, radiological and microbiological profiles of bronchiectasis patients and to evaluate these parameters with respect to the occurrence of haemoptysis.
Design
Cross-sectional prospective evaluation
Methods
Patients with proven bronchiectasis by high resolution computed tomography (HRCT) at their steady state were recruited from a specialist respiratory clinic. Various parameters including the aetiology, clinical features, radiology, physiological function and microbiological characteristics were evaluated. These results were further analyzed by comparing patients with and without experience of haemoptysis.
Results
129 patients with bronchiectasis were evaluated. They were predominantly female with onset of symptoms at their forties. 72% of them were idiopathic. The most commonly reported symptoms, in descending order, were cough, fatigue, exercise intolerance, wheeze and haemoptysis. Haemoptysis occurred in 38% of the patients. In comparing patients with and without haemoptysis, those in the haemoptysis group had significantly better lung function indices including the forced expiratory flow in one second (FEV1) and forced vital capacity (FVC), with a difference of 300ml and 400ml respectively. History of smoking appeared to be related to the occurrence of haemoptysis, although not statistically significant (p=0.053). No statistically significant difference was observed in relation to a history of tuberculosis with haemoptysis. Fatigue and reduction in exercise intolerance were less common among patients with haemoptysis, though not statistically significant (p=0.065 and 0.061 respectively). Right lower lobe involvement had a significant effect to the prediction of the status of haemoptysis by logistical regression (p=0.01). Right lung involvement was also significant in predicting the occurrence of haemoptysis (p=0.049). There was no difference in the sputum characteristics, microbiology, exacerbation and quality of life (St George’s Respiratory Questionnaire) when comparing patients with and without haemoptysis.
There were 75 patients who could recall the number of haemoptysis episodes in the past 12 months. Of these, 26 had at least one episode (mean 1.52 ±3.78) in the past 12 months. The duration, measured as the number of days, for each time was 2.46 ±2.44. Thirteen out of 26 patients had fresh haemoptysis but produced only small amount of sputum (84.6% produced less than 20ml/day). Sputum production of more than 5ml daily was significantly related to the occurrence of haemoptysis (p=0.04).
Conclusion
Haemoptysis occurs in 38% of patients. Better lung function is observed in the group of patients with haemoptysis than their counterparts. They are more likely to be non-smokers. Right lower lobe involvement is found to have a significant effect and right lung involvement is slightly significant to the occurrence of haemoptysis. The two groups do not differ in sputum characteristics, pathogens identified in sputum, quality of life and exacerbation frequency. For fresh haemoptysis, daily sputum production of more than 5ml is significantly related to the occurrence of haemoptysis.
