{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T06:35:46Z","timestamp":1791527746491,"version":"4.3.4"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,3,9]],"date-time":"2022-03-09T00:00:00Z","timestamp":1646784000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,3,9]],"date-time":"2022-03-09T00:00:00Z","timestamp":1646784000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"a grant from the Korea Health Technology R&D Project through the Korean Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea","award":["grant no. HI18C0522"],"award-info":[{"award-number":["grant no. HI18C0522"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>With the increasing use of computed tomography, bronchiectasis has become a common finding in patients with chronic obstructive pulmonary disease (COPD). However, the clinical aspects and medical utilization of COPD with bronchiectasis (BE) remain unclear. We aimed to investigate the BE effect on prognosis and medical utilization in patients with COPD. Among 263,747 COPD patients, we excluded patients lacking chest X-ray, CT, or pulmonary function test codes and classified 2583 GOLD-C\/D patients matched according to age, sex, and medical aid as having COPD-BE (447 [17.3%]) and COPD without BE (2136 [82.7%]). Patients with COPD-BE showed a higher rate of acute exacerbation requiring antibiotics than those without BE. Moreover, multivariable analysis showed that BE co-existence was a crucial factor for moderate-to-severe exacerbation (incidence rate ratio [IRR] 1.071; 95% CI 1.012\u20131.134; <jats:italic>p<\/jats:italic>\u2009=\u20090.019). Patients with COPD-BE had a significantly higher rate of exacerbations requiring antibiotics, as well as treatment cost and duration (meant as number of days using hospitalization plus outpatient appointment), than those with COPD without BE (52.64\u2009\u00b1\u200965.29 vs. 40.19\u2009\u00b1\u200950.02\u00a0days, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001; 5984.08\u2009\u00b1\u20098316.96 vs. 4453.40\u2009\u00b1\u20097291.03 USD, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Compared with patients with COPD without BE, patients with COPD-BE experienced more exacerbations requiring antibiotics, more hospitalizations, and a higher medical cost.\n<\/jats:p>","DOI":"10.1038\/s41598-022-07772-6","type":"journal-article","created":{"date-parts":[[2022,3,9]],"date-time":"2022-03-09T11:03:12Z","timestamp":1646823792000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Increased hospitalizations and economic burden in COPD with bronchiectasis: a nationwide representative study"],"prefix":"10.1038","volume":"12","author":[{"given":"Youlim","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyungjoo","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chin Kook","family":"Rhee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Won","family":"Ra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,3,9]]},"reference":[{"key":"7772_CR1","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1183\/09031936.00170014","volume":"45","author":"JR Hurst","year":"2015","unstructured":"Hurst, J. R., Elborn, J. S., De Soyza, A., Consortium, B.-U. COPD-bronchiectasis overlap syndrome. Eur. Respir. J. 45, 310\u2013313. https:\/\/doi.org\/10.1183\/09031936.00170014 (2015).","journal-title":"Eur. Respir. J."},{"key":"7772_CR2","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1136\/thorax.55.8.635","volume":"55","author":"C O'Brien","year":"2000","unstructured":"O\u2019Brien, C., Guest, P. J., Hill, S. L. & Stockley, R. A. Physiological and radiological characterisation of patients diagnosed with chronic obstructive pulmonary disease in primary care. Thorax 55, 635\u2013642. https:\/\/doi.org\/10.1136\/thorax.55.8.635 (2000).","journal-title":"Thorax"},{"key":"7772_CR3","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa073","author":"RA Stockley","year":"2020","unstructured":"Stockley, R. A. Bronchiectasis; a progressive phenotype of chronic obstructive pulmonary disease. Clin. Infect. Dis. https:\/\/doi.org\/10.1093\/cid\/ciaa073 (2020).","journal-title":"Clin. Infect. Dis."},{"key":"7772_CR4","doi-asserted-by":"publisher","first-page":"1465","DOI":"10.2147\/COPD.S83910","volume":"10","author":"Y Ni","year":"2015","unstructured":"Ni, Y. et al. Clinical characteristics of patients with chronic obstructive pulmonary disease with comorbid bronchiectasis: A systemic review and meta-analysis. Int. J. Chron. Obstruct. Pulm. Dis. 10, 1465\u20131475. https:\/\/doi.org\/10.2147\/COPD.S83910 (2015).","journal-title":"Int. J. Chron. Obstruct. Pulm. Dis."},{"key":"7772_CR5","doi-asserted-by":"publisher","first-page":"1900194","DOI":"10.1183\/13993003.00194-2019","volume":"54","author":"H Choi","year":"2019","unstructured":"Choi, H. et al. Population-based prevalence of bronchiectasis and associated comorbidities in South Korea. Eur. Respir. J. 54, 1900194. https:\/\/doi.org\/10.1183\/13993003.00194-2019 (2019).","journal-title":"Eur. Respir. J."},{"key":"7772_CR6","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1378\/chest.10-3007","volume":"140","author":"M Bafadhel","year":"2011","unstructured":"Bafadhel, M. et al. The role of CT scanning in multidimensional phenotyping of COPD. Chest 140, 634\u2013642. https:\/\/doi.org\/10.1378\/chest.10-3007 (2011).","journal-title":"Chest"},{"key":"7772_CR7","doi-asserted-by":"publisher","first-page":"605","DOI":"10.3109\/15412555.2014.922174","volume":"11","author":"T Gatheral","year":"2014","unstructured":"Gatheral, T. et al. COPD-related bronchiectasis; independent impact on disease course and outcomes. COPD 11, 605\u2013614. https:\/\/doi.org\/10.3109\/15412555.2014.922174 (2014).","journal-title":"COPD"},{"key":"7772_CR8","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1378\/chest.10-1758","volume":"140","author":"MA Martinez-Garcia","year":"2011","unstructured":"Martinez-Garcia, M. A. et al. Factors associated with bronchiectasis in patients with COPD. Chest 140, 1130\u20131137. https:\/\/doi.org\/10.1378\/chest.10-1758 (2011).","journal-title":"Chest"},{"key":"7772_CR9","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1111\/j.1440-1843.2006.00930.x","volume":"11","author":"K Fujimoto","year":"2006","unstructured":"Fujimoto, K., Kitaguchi, Y., Kubo, K. & Honda, T. Clinical analysis of chronic obstructive pulmonary disease phenotypes classified using high-resolution computed tomography. Respirology 11, 731\u2013740. https:\/\/doi.org\/10.1111\/j.1440-1843.2006.00930.x (2006).","journal-title":"Respirology"},{"key":"7772_CR10","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1155\/2013\/727523","volume":"20","author":"B Tulek","year":"2013","unstructured":"Tulek, B., Kivrak, A. S., Ozbek, S., Kanat, F. & Suerdem, M. Phenotyping of chronic obstructive pulmonary disease using the modified Bhalla scoring system for high-resolution computed tomography. Can. Respir. J. 20, 91\u201396. https:\/\/doi.org\/10.1155\/2013\/727523 (2013).","journal-title":"Can. Respir. J."},{"key":"7772_CR11","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1164\/rccm.201208-1518OC","volume":"187","author":"MA Martinez-Garcia","year":"2013","unstructured":"Martinez-Garcia, M. A. et al. Prognostic value of bronchiectasis in patients with moderate-to-severe chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 187, 823\u2013831. https:\/\/doi.org\/10.1164\/rccm.201208-1518OC (2013).","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"7772_CR12","doi-asserted-by":"publisher","first-page":"e0166745","DOI":"10.1371\/journal.pone.0166745","volume":"11","author":"WC Tan","year":"2016","unstructured":"Tan, W. C. et al. Findings on thoracic computed tomography scans and respiratory outcomes in persons with and without chronic obstructive pulmonary disease: A population-based cohort study. PLoS ONE 11, e0166745. https:\/\/doi.org\/10.1371\/journal.pone.0166745 (2016).","journal-title":"PLoS ONE"},{"key":"7772_CR13","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1186\/1465-9921-11-122","volume":"11","author":"A Agusti","year":"2010","unstructured":"Agusti, A. et al. Characterisation of COPD heterogeneity in the ECLIPSE cohort. Respir. Res. 11, 122. https:\/\/doi.org\/10.1186\/1465-9921-11-122 (2010).","journal-title":"Respir. Res."},{"key":"7772_CR14","doi-asserted-by":"publisher","first-page":"e0150532","DOI":"10.1371\/journal.pone.0150532","volume":"11","author":"Q Du","year":"2016","unstructured":"Du, Q., Jin, J., Liu, X. & Sun, Y. Bronchiectasis as a comorbidity of chronic obstructive pulmonary disease: A systematic review and meta-analysis. PLoS ONE 11, e0150532. https:\/\/doi.org\/10.1371\/journal.pone.0150532 (2016).","journal-title":"PLoS ONE"},{"key":"7772_CR15","doi-asserted-by":"publisher","first-page":"1900164","DOI":"10.1183\/13993003.00164-2019","volume":"53","author":"D Singh","year":"2019","unstructured":"Singh, D. et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: The GOLD science committee report 2019. Eur. Respir. J. 53, 1900164. https:\/\/doi.org\/10.1183\/13993003.00164-2019 (2019).","journal-title":"Eur. Respir. J."},{"key":"7772_CR16","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1183\/09031936.00122508","volume":"33","author":"MP Murray","year":"2009","unstructured":"Murray, M. P., Turnbull, K., Macquarrie, S. & Hill, A. T. Assessing response to treatment of exacerbations of bronchiectasis in adults. Eur. Respir. J. 33, 312\u2013318. https:\/\/doi.org\/10.1183\/09031936.00122508 (2009).","journal-title":"Eur. Respir. J."},{"key":"7772_CR17","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1183\/09031936.00090311","volume":"40","author":"R Wilson","year":"2012","unstructured":"Wilson, R. et al. Moxifloxacin versus amoxicillin\/clavulanic acid in outpatient acute exacerbations of COPD: MAESTRAL results. Eur. Respir. J. 40, 17\u201327. https:\/\/doi.org\/10.1183\/09031936.00090311 (2012).","journal-title":"Eur. Respir. J."},{"key":"7772_CR18","doi-asserted-by":"publisher","first-page":"147997311983996","DOI":"10.1177\/1479973119839961","volume":"16","author":"FD Seifer","year":"2019","unstructured":"Seifer, F. D., Hansen, G. & Weycker, D. Health-care utilization and expenditures among patients with comorbid bronchiectasis and chronic obstructive pulmonary disease in US clinical practice. Chron. Respir. Dis. 16, 1479973119839961. https:\/\/doi.org\/10.1177\/1479973119839961 (2019).","journal-title":"Chron. Respir. Dis."},{"key":"7772_CR19","doi-asserted-by":"publisher","first-page":"1825","DOI":"10.1378\/chest.06-2280","volume":"131","author":"WJ Koh","year":"2007","unstructured":"Koh, W. J. et al. Prevalence of gastroesophageal reflux disease in patients with nontuberculous mycobacterial lung disease. Chest 131, 1825\u20131830. https:\/\/doi.org\/10.1378\/chest.06-2280 (2007).","journal-title":"Chest"},{"key":"7772_CR20","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1378\/chest.127.3.825","volume":"127","author":"M John","year":"2005","unstructured":"John, M. et al. Anemia and inflammation in COPD. Chest 127, 825\u2013829. https:\/\/doi.org\/10.1378\/chest.127.3.825 (2005).","journal-title":"Chest"},{"key":"7772_CR21","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1016\/S2213-2600(16)30320-4","volume":"4","author":"MJ McDonnell","year":"2016","unstructured":"McDonnell, M. J. et al. Comorbidities and the risk of mortality in patients with bronchiectasis: An international multicentre cohort study. Lancet Respir. Med. 4, 969\u2013979. https:\/\/doi.org\/10.1016\/S2213-2600(16)30320-4 (2016).","journal-title":"Lancet Respir. Med."},{"key":"7772_CR22","doi-asserted-by":"publisher","first-page":"163","DOI":"10.3109\/15412555.2013.831061","volume":"11","author":"CK Rhee","year":"2014","unstructured":"Rhee, C. K. et al. Medical utilization and cost in patients with overlap syndrome of chronic obstructive pulmonary disease and asthma. COPD 11, 163\u2013170. https:\/\/doi.org\/10.3109\/15412555.2013.831061 (2014).","journal-title":"COPD"},{"key":"7772_CR23","doi-asserted-by":"publisher","first-page":"27","DOI":"10.2147\/COPD.S121687","volume":"12","author":"J Lee","year":"2017","unstructured":"Lee, J., Lee, J. H., Kim, J. A. & Rhee, C. K. Trend of cost and utilization of COPD medication in Korea. Int. J. Chron. Obstruct. Pulm. Dis. 12, 27\u201333. https:\/\/doi.org\/10.2147\/COPD.S121687 (2017).","journal-title":"Int. J. Chron. Obstruct. Pulm. Dis."},{"key":"7772_CR24","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1007\/s40261-017-0612-2","volume":"38","author":"JA Kim","year":"2018","unstructured":"Kim, J. A., Lim, M. K., Kim, K., Park, J. & Rhee, C. K. Adherence to inhaled medications and its effect on healthcare utilization and costs among high-grade chronic obstructive pulmonary disease patients. Clin. Drug Investig. 38, 333\u2013340. https:\/\/doi.org\/10.1007\/s40261-017-0612-2 (2018).","journal-title":"Clin. Drug Investig."},{"key":"7772_CR25","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.2147\/COPD.S159249","volume":"13","author":"SC Park","year":"2018","unstructured":"Park, S. C. et al. Hemoglobin and mortality in patients with COPD: A nationwide population-based cohort study. Int. J. Chron. Obstruct. Pulm. Dis. 13, 1599\u20131605. https:\/\/doi.org\/10.2147\/COPD.S159249 (2018).","journal-title":"Int. J. Chron. Obstruct. Pulm. Dis."},{"key":"7772_CR26","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1186\/1471-2466-13-51","volume":"13","author":"J Kim","year":"2013","unstructured":"Kim, J. et al. Association between chronic obstructive pulmonary disease and gastroesophageal reflux disease: A national cross-sectional cohort study. BMC Pulm. Med. 13, 51. https:\/\/doi.org\/10.1186\/1471-2466-13-51 (2013).","journal-title":"BMC Pulm. Med."},{"key":"7772_CR27","doi-asserted-by":"publisher","first-page":"1272","DOI":"10.3904\/kjim.2017.428","volume":"34","author":"SC Park","year":"2019","unstructured":"Park, S. C. et al. Mortality of patients with chronic obstructive pulmonary disease: A nationwide population based cohort study. Korean J. Intern. Med. 34, 1272\u20131278. https:\/\/doi.org\/10.3904\/kjim.2017.428 (2019).","journal-title":"Korean J. Intern. Med."},{"key":"7772_CR28","doi-asserted-by":"publisher","first-page":"175346662096168","DOI":"10.1177\/1753466620961688","volume":"14","author":"YS Jo","year":"2020","unstructured":"Jo, Y. S., Rhee, C. K., Kim, K. J., Yoo, K. H. & Park, Y. B. Risk factors for early readmission after acute exacerbation of chronic obstructive pulmonary disease. Ther. Adv. Respir. Dis. 14, 1753466620961688. https:\/\/doi.org\/10.1177\/1753466620961688 (2020).","journal-title":"Ther. Adv. Respir. Dis."},{"key":"7772_CR29","doi-asserted-by":"publisher","first-page":"1367","DOI":"10.2147\/COPD.S248616","volume":"15","author":"YS Jo","year":"2020","unstructured":"Jo, Y. S. et al. Relationship between changes in inhalation treatment level and exacerbation of chronic obstructive pulmonary disease: Nationwide the health insurance and assessment service database. Int. J. Chron. Obstruct. Pulm. Dis. 15, 1367\u20131375. https:\/\/doi.org\/10.2147\/COPD.S248616 (2020).","journal-title":"Int. J. Chron. Obstruct. Pulm. Dis."},{"key":"7772_CR30","doi-asserted-by":"publisher","first-page":"6049","DOI":"10.1038\/s41598-020-63064-x","volume":"10","author":"HJ Park","year":"2020","unstructured":"Park, H. J. et al. Frequent outpatient visits prevent exacerbation of chronic obstructive pulmonary disease. Sci. Rep. 10, 6049. https:\/\/doi.org\/10.1038\/s41598-020-63064-x (2020).","journal-title":"Sci. Rep."},{"key":"7772_CR31","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1111\/resp.13678","volume":"25","author":"HY Park","year":"2020","unstructured":"Park, H. Y. et al. Impact of chronic obstructive pulmonary disease on mortality: A large national cohort study. Respirology 25, 726\u2013734. https:\/\/doi.org\/10.1111\/resp.13678 (2020).","journal-title":"Respirology"},{"key":"7772_CR32","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1136\/thoraxjnl-2019-213732","volume":"75","author":"HY Park","year":"2020","unstructured":"Park, H. Y. et al. Chronic obstructive pulmonary disease and lung cancer incidence in never smokers: A cohort study. Thorax 75, 506\u2013509. https:\/\/doi.org\/10.1136\/thoraxjnl-2019-213732 (2020).","journal-title":"Thorax"},{"key":"7772_CR33","doi-asserted-by":"publisher","first-page":"561","DOI":"10.2147\/COPD.S48577","volume":"8","author":"J Kim","year":"2013","unstructured":"Kim, J. et al. The health care burden of high grade chronic obstructive pulmonary disease in Korea: Analysis of the Korean Health Insurance Review and Assessment Service data. Int. J. Chron. Obstruct. Pulm. Dis. 8, 561\u2013568. https:\/\/doi.org\/10.2147\/COPD.S48577 (2013).","journal-title":"Int. J. Chron. Obstruct. Pulm. Dis."},{"key":"7772_CR34","doi-asserted-by":"publisher","first-page":"737","DOI":"10.5588\/ijtld.13.0634","volume":"18","author":"C Kim","year":"2014","unstructured":"Kim, C. et al. Health care use and economic burden of patients with diagnosed chronic obstructive pulmonary disease in Korea. Int. J. Tuberc. Lung Dis. 18, 737\u2013743. https:\/\/doi.org\/10.5588\/ijtld.13.0634 (2014).","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"7772_CR35","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1164\/rccm.200305-648OC","volume":"170","author":"IS Patel","year":"2004","unstructured":"Patel, I. S. et al. Bronchiectasis, exacerbation indices, and inflammation in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 170, 400\u2013407. https:\/\/doi.org\/10.1164\/rccm.200305-648OC (2004).","journal-title":"Am. J. Respir. Crit. Care Med."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-07772-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-07772-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-07772-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,24]],"date-time":"2022-11-24T23:35:57Z","timestamp":1669332957000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-07772-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,9]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["7772"],"URL":"https:\/\/doi.org\/10.1038\/s41598-022-07772-6","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,9]]},"assertion":[{"value":"16 April 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 February 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 March 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"3829"}}