The impact of COPD-bronchiectasis association on clinical outcomes: insights from East Asian cohorts validating the ROSE criteria

Yen-Fu Chen^{1

2

3}, Chia-Ling Chang^{2

4}, Hsin-Han Hou⁵, Ning Chien⁶, Kai-Zen Lu⁷, Ying-Yin Chen⁸, Zheng-Ci Hung⁷, Yi-Han Hsiao^{9

10}, Chau-Chyun Sheu^{11

12}, Ping-Huai Wang¹³, Meng-Heng Hsieh^{14

15}, Wu-Huei Hsu^{16

17

18}, Ming-Tsung Chen¹⁹, Wei-Fan Ou²⁰, Yu-Feng Wei^{21

22}, Tsung-Ming Yang²³, Chou-Chin Lan²⁴, Cheng-Yi Wang²⁵, Chih-Bin Lin^{26

27}, Ming-Shian Lin²⁸, Yao-Tung Wang^{29

30}, Ching-Hsiung Lin^{31

32

33

34}, Shih-Feng Liu^{35

36

37}, Meng-Hsuan Cheng^{11

38}, Wen-Chien Cheng¹⁶, Chung-Kan Peng¹⁹, Ming-Cheng Chan^{39

40}, Ching-Yi Chen²¹, Lun-Yu Jao^{24

27}, Ya-Hui Wang⁴¹, Chi-Jui Chen²⁶, Shih-Pin Chen^{29

30}, Yi-Hsuan Tsai^{35

42}, Shih-Lung Cheng^{13

43}, Horng-Chyuan Lin^{14

15

44}, Jung-Yien Chien⁷, Hao-Chien Wang^{7

45

46}, Chong-Jen Yu^{2

4

7

46}

Affiliations

¹ Department of Internal Medicine, National Taiwan University Hospital, Yunlin Branch, Douliu, Taiwan.
² Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
³ Thoracic Medicine Center, Department of Medicine and Surgery, National Taiwan University Hospital, Yunlin Branch, Douliu, Taiwan.
⁴ Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan.
⁵ Graduate Institute of Oral Biology, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁶ Department of Medical Imaging, National Taiwan University Cancer Center, Taipei, Taiwan.
⁷ Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁸ Precision Medicine Center, National Taiwan University Hospital, Yunlin Branch, Hu-Wei, Taiwan.
⁹ Division of General Chest Medicine, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
¹⁰ School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹¹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
¹² Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹³ Division of Thoracic Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
¹⁴ Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
¹⁵ College of Medicine, Chang Gung University, Taoyuan, Taiwan.
¹⁶ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
¹⁷ Critical Medical Center, China Medical University Hospital, Taichung, Taiwan.
¹⁸ School of Medicine, China Medical University, Taichung, Taiwan.
¹⁹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
²⁰ Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
²¹ Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan.
²² School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
²³ Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
²⁴ Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
²⁵ Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
²⁶ Division of Pulmonary Medicine, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
²⁷ School of Medicine, Tzu-Chi University, Hualien, Taiwan.
²⁸ Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.
²⁹ Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
³⁰ School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
³¹ Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua, Taiwan.
³² Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan.
³³ PhD Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan.
³⁴ Department of Recreation and Holistic Wellness, MingDao University, Changhua, Taiwan.
³⁵ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
³⁶ Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
³⁷ Chang Gung University College of Medicine, Taoyuan, Taiwan.
³⁸ Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
³⁹ Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
⁴⁰ School of Post Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁴¹ Medical Research Center, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
⁴² Department of Pulmonary Medicine, Lee's Clinic, Pingtung, Taiwan.
⁴³ Department of Chemical Engineering and Materials Science, Yuan Ze University, Taoyuan City, Taiwan.
⁴⁴ Department of Respiratory Therapy, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
⁴⁵ Department of Medicine, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan.
⁴⁶ H-C. Wang and C-J. Yu contributed equally to this article as lead authors and supervised the work.

PMID: 40071267
PMCID: PMC11895104
DOI: 10.1183/23120541.00626-2024

The impact of COPD-bronchiectasis association on clinical outcomes: insights from East Asian cohorts validating the ROSE criteria

Yen-Fu Chen et al. ERJ Open Res. 2025.

. 2025 Mar 10;11(2):00626-2024.

doi: 10.1183/23120541.00626-2024. eCollection 2025 Mar.

Authors

Affiliations

¹ Department of Internal Medicine, National Taiwan University Hospital, Yunlin Branch, Douliu, Taiwan.
² Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
³ Thoracic Medicine Center, Department of Medicine and Surgery, National Taiwan University Hospital, Yunlin Branch, Douliu, Taiwan.
⁴ Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan.
⁵ Graduate Institute of Oral Biology, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁶ Department of Medical Imaging, National Taiwan University Cancer Center, Taipei, Taiwan.
⁷ Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁸ Precision Medicine Center, National Taiwan University Hospital, Yunlin Branch, Hu-Wei, Taiwan.
⁹ Division of General Chest Medicine, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
¹⁰ School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹¹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
¹² Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹³ Division of Thoracic Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
¹⁴ Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
¹⁵ College of Medicine, Chang Gung University, Taoyuan, Taiwan.
¹⁶ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
¹⁷ Critical Medical Center, China Medical University Hospital, Taichung, Taiwan.
¹⁸ School of Medicine, China Medical University, Taichung, Taiwan.
¹⁹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
²⁰ Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
²¹ Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan.
²² School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
²³ Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
²⁴ Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
²⁵ Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
²⁶ Division of Pulmonary Medicine, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
²⁷ School of Medicine, Tzu-Chi University, Hualien, Taiwan.
²⁸ Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.
²⁹ Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
³⁰ School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
³¹ Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua, Taiwan.
³² Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan.
³³ PhD Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan.
³⁴ Department of Recreation and Holistic Wellness, MingDao University, Changhua, Taiwan.
³⁵ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
³⁶ Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
³⁷ Chang Gung University College of Medicine, Taoyuan, Taiwan.
³⁸ Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
³⁹ Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
⁴⁰ School of Post Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁴¹ Medical Research Center, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
⁴² Department of Pulmonary Medicine, Lee's Clinic, Pingtung, Taiwan.
⁴³ Department of Chemical Engineering and Materials Science, Yuan Ze University, Taoyuan City, Taiwan.
⁴⁴ Department of Respiratory Therapy, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
⁴⁵ Department of Medicine, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan.
⁴⁶ H-C. Wang and C-J. Yu contributed equally to this article as lead authors and supervised the work.

PMID: 40071267
PMCID: PMC11895104
DOI: 10.1183/23120541.00626-2024

Abstract

Background: The radiology, obstruction, symptoms and exposure (ROSE) criteria provide a standardised approach for identifying the "COPD-bronchiectasis (BE) association." However, the clinical implications and outcomes of the COPD-BE association in East Asian populations remain unclear. Our study applied the ROSE criteria to assess the prevalence, clinical impact and outcomes of the COPD-BE association in an East Asian cohort, and compared that cohort with nonsmoking BE patients with fixed airflow obstruction (FAO) and those without FAO.

Methods: An integrated cohort analysis was conducted within a Taiwanese demographic, combining a prospective cohort of 147 participants with a multicentre retrospective cohort of 574 participants. Stratification was based on the ROSE criteria, distinguishing between nonsmoking BE, smoking BE, nonsmoking BE with FAO and BE in compliance with the ROSE criteria. Clinical, radiological and spirometric variables were assessed in conjunction with outcomes to validate the diagnostic utility of the criteria.

Results: Using the ROSE criteria, we found that 16.5% of participants had a COPD-BE association (22.4% in the prospective cohort and 14.9% in the retrospective cohort), predominantly in older male patients. These patients had escalated dyspnoea scores, higher COPD diagnosis rates and increased use of inhalation therapies, compared with those without FAO. Notably, patients with a COPD-BE association and nonsmoking BE with FAO displayed similar clinical symptoms, pulmonary function and disease severity, but differed slightly in airway microbiology. Furthermore, patients with a COPD-BE association had significantly higher risks of exacerbations and hospitalisations, even after adjusting for confounding factors, which highlights that they have poorer clinical outcomes than other groups.

Conclusion: The ROSE criteria effectively identify the COPD-BE association in East Asian populations, highlighting a significant future exacerbation risk compared with other BE groups. Future research is warranted to better understand BE progression, especially in FAO subgroups.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: All authors declare that there is no conflict of interest.

Figures

**FIGURE 1**
The flow of patients recruited to: a) the prospective cohort and b) the retrospective cohort. HRCT: high-resolution computed tomography; ABPA: allergic bronchopulmonary aspergillosis; BAL: bronchoalveolar lavage; FEV₁: forced expiratory volume in 1 s; FVC: forced vital capacity; BE: bronchiectasis; BE-FAO: bronchiectasis with fixed airflow obstruction; PY: pack-years, ROSE: radiological bronchiectasis, obstruction defined by a post-bronchodilator FEV₁/FVC ratio of <0.7, symptoms and exposure to a minimum of 10 pack-years of smoking; TBARC: Taiwan Bronchiectasis Research Collaboration.

**FIGURE 2**
In the prospective cohort, a) the Kaplan–Meier plot illustrates the time to the first exacerbation among different bronchiectasis subgroups with a median follow-up of 2.8 years (interquartile range (IQR) 1.6–4.2 years). The plot compares four groups: nonsmoking bronchiectasis (BE), smoking BE, nonsmoking BE with fixed airflow obstruction (FAO) and COPD–BE association. b) The Kaplan–Meier plot illustrates the time to first hospitalisation among different bronchiectasis subgroups with a median follow-up of 2.8 years (IQR 1.6–4.2 years). The groups analysed were nonsmoking BE, smoking BE, nonsmoking BE with FAO and COPD–BE association. *: p<0.05.

**FIGURE 3**
Incidence rate ratios (IRRs) for the risk of exacerbation of bronchiectasis (BE) among the four subgroups in: a) the prospective cohort and b) the retrospective cohort. Nonsmoking BE was used as the reference group (IRR 1.0). The IRR values for the other subgroups, compared with the nonsmoking BE subgroup, are as follows. Prospective cohort: smoking BE, IRR 1.14 (95% confidence interval (CI) 0.55–2.37; p=0.709); nonsmoking BE with FAO, IRR 2.37 (95% CI 1.42–3.95; p=0.001); and COPD–BE association, IRR 3.68 (95% CI 2.32–5.86; p<0.001). Retrospective cohort: smoking BE, IRR 0.88 (95% CI 0.51–1.53; p=0.667); nonsmoking BE with FAO, IRR 1.83 (95% CI 1.21–2.76; p=0.004); and COPD–BE association, IRR 2.04 (95% CI 1.33–3.31; p=0.004).

See this image and copyright information in PMC

References

1. Flume PA, Chalmers JD, Olivier KN. Advances in bronchiectasis: endotyping, genetics, microbiome, and disease heterogeneity. Lancet 2018; 392: 880–890. doi: 10.1016/S0140-6736(18)31767-7 - DOI - PMC - PubMed
1. Polverino E, Goeminne PC, McDonnell MJ,et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J 2017; 50: 1700629. doi: 10.1183/13993003.00629-2017 - DOI - PubMed
1. Naidich DP, McCauley DI, Khouri NF, et al. Computed tomography of bronchiectasis. J Comput Assist Tomogr 1982; 6: 437–444. doi: 10.1097/00004728-198206000-00001 - DOI - PubMed
1. Agusti A, Celli BR, Criner GJ, et al. Global Initiative for Chronic Obstructive Lung Disease 2023 report: GOLD executive summary. Eur Respir J 2023; 61: 2300239. doi: 10.1183/13993003.00239-2023 - DOI - PMC - PubMed
1. Pasteur MC, Bilton D, Hill AT, British Thoracic Society Bronchiectasis non-CF Guideline Group . British Thoracic Society guideline for non-CF bronchiectasis. Thorax 2010; 65: Suppl. 1, i1–i58. doi: 10.1136/thx.2010.136119 - DOI - PubMed

LinkOut - more resources

Full Text Sources
- PubMed Central

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

The impact of COPD-bronchiectasis association on clinical outcomes: insights from East Asian cohorts validating the ROSE criteria

Affiliations

The impact of COPD-bronchiectasis association on clinical outcomes: insights from East Asian cohorts validating the ROSE criteria

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources