Prevalence of Bronchiectasis in India
The prevalence of bronchiectasis in India is approximately 35.5% due to post-tuberculosis etiology, which is significantly higher than rates reported in Western countries, according to the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry. 1
Epidemiological Data from India
The Indian bronchiectasis registry, which enrolled 2,195 patients from 31 centers across India between 2015 and 2017, provides the most comprehensive data on bronchiectasis prevalence in India. This registry revealed several key characteristics that distinguish the Indian bronchiectasis population from Western cohorts:
- Patients in India are younger (median age 56 years) compared to European and US registries 1
- Male predominance (56.9%) in India versus female predominance in Western countries 1
- Previous tuberculosis is the most common underlying cause (35.5% of cases) 1
- Pseudomonas aeruginosa is the most common organism isolated from sputum (13.7%) 1
Risk Factors for Poor Outcomes in Indian Patients
The EMBARC-India registry follow-up study of 1,018 patients identified several risk factors associated with poor outcomes:
- Frequent exacerbations (≥3 per year) significantly increase mortality risk (HR 3.23) 2
- Coexisting COPD, dyspnoea, and current cigarette smoking are associated with worse outcomes 2
- Infection with Gram-negative pathogens (predominantly Klebsiella pneumoniae) is independently associated with increased mortality (HR 3.13) 2
- Pseudomonas aeruginosa infection is associated with severe exacerbations requiring hospitalization (HR 1.41) 2
Comparison with Global Prevalence
The prevalence of bronchiectasis varies significantly worldwide:
- In Western countries, prevalence ranges from 53 to 566 cases per 100,000 inhabitants 3
- Prevalence increases with age (7 per 100,000 in individuals 18-34 years vs 812 per 100,000 in those ≥75 years) 4
- In the US, prevalence increases from 4.2 per 100,000 persons aged 18-34 years to 271.8 per 100,000 among those aged 75 years or older 5
Etiology Differences
The etiology of bronchiectasis in India differs markedly from Western populations:
- Post-tuberculosis bronchiectasis is the predominant cause in India (35.5%) 1
- In contrast, Western populations show higher rates of idiopathic causes (up to 38%), GERD (47%), asthma (29%), and COPD (20%) 4
Quality of Care Concerns
The Indian registry highlighted significant gaps in care quality:
- Only 388 patients were tested for allergic bronchopulmonary aspergillosis 1
- Only 82 patients had been tested for immunoglobulins 1
- Overall low adherence to guideline-recommended care was observed 1
Clinical Implications
The high prevalence of post-tuberculosis bronchiectasis in India has important clinical implications:
- Patients with a history of pulmonary tuberculosis have a higher risk of exacerbations (adjusted incidence rate ratio 1.20) 1
- These patients require targeted management strategies that may differ from approaches used in Western populations
- Improved tuberculosis prevention and treatment programs could potentially reduce bronchiectasis prevalence in India
Pitfalls and Caveats
- The data from the Indian registry may not represent the entire Indian population due to referral bias to specialized centers
- Diagnostic capabilities vary across India, potentially leading to underdiagnosis in resource-limited settings
- The high prevalence of post-tuberculosis bronchiectasis highlights the need for early detection and management of tuberculosis to prevent this complication
The high prevalence of bronchiectasis in India, particularly due to post-tuberculosis etiology, underscores the need for improved tuberculosis control measures, early diagnosis of bronchiectasis, and adherence to evidence-based management guidelines to reduce the associated morbidity and mortality.