COPD and Bronchiectasis Overlap: Coincidence or Phenotype?

The coexistence of chronic obstructive pulmonary disease (COPD) and bronchiectasis is increasingly recognized as a distinct clinical phenotype that presents unique diagnostic and therapeutic challenges. This overlap syndrome is characterized by heightened airway inflammation, frequent bacterial colonization, and a greater burden of respiratory symptoms, leading to poorer clinical outcomes. In this review, we explore the pathophysiological mechanisms underlying COPD-bronchiectasis overlap, emphasizing the role of chronic infection, impaired mucociliary clearance, and structural lung damage in driving disease progression. Bronchiectasis in COPD patients is associated with increased airflow obstruction, higher exacerbation rates, and greater disease severity compared to COPD alone. The shared pathophysiology includes chronic inflammation, often initiated by cigarette smoke or other environmental pollutants, and recurrent infections, especially with pathogens like Pseudomonas aeruginosa. These infections create a vicious cycle of inflammation and bronchial wall damage, resulting in airway dilation and impaired lung function. Diagnosing bronchiectasis in COPD patients remains challenging due to overlapping symptoms. High-resolution computed tomography (HRCT) is essential for identifying bronchial abnormalities, while spirometry confirms obstructive patterns. This review also highlights the need for tailored therapeutic strategies, including aggressive management of infections, use of long-acting bronchodilators, and cautious application of inhaled corticosteroids, which may exacerbate inflammation in patients with bronchiectasis. By recognizing COPD-bronchiectasis overlap as a distinct phenotype, we aim to improve clinical outcomes through a more personalized and comprehensive approach to diagnosis and treatment, ultimately enhancing patient quality of life.