Asthma features in severe COPD: Identifying treatable traits.

AIM Biological therapies developed for severe asthma may have a role in COPD patients with asthma features. METHOD We carried out a prospective, consecutive, cross-sectional analysis of 80 patients with severe COPD GOLD IV/D. RESULTS We studied 80 patients (48.8% female), aged 57.6 ± 5.1 years, ex-smokers with 35.7 ± 21.2 pack years, BMI 22.3 ± 3.5 kg/m2, FEV1 of 0.61 ± 0.2 L (21.1 ± 5.6% pred), pO2 52.4 ± 8.4 mmHg, and BODE 6.9 ± 1.7. 68% had >2 moderate or severe exacerbations annually. 16.1% (5/31) patients showed FEV1 reversibility of >12% and >200 ml despite maximal therapy, 33% (15/45) had FENO ≥22.5 ppb, 33% (24/73) had serum IgE ≥100 I.E./ml and there was positive allergen sensitization in 51.5% (35/68). Blood eosinophilia of ≥150 cells/μl was seen in 47% (35/74). Induced sputum showed eosinophilia of ≥2% in 56% (14/24) with respiratory pathogens in 63.8% (30/47). We identified 12 (15%) patients with asthma-COPD overlap. Of these, 10 (83.3%) had frequent exacerbations and these patients had significantly more severe exacerbations requiring NIV or ICU than those without asthma features (p < 0.005). CONCLUSION We detected asthma features in a substantial subset of stable patients with severe COPD. Asthma features were associated with more severe exacerbation despite optimal COPD therapy, representing potential candidates for targeted therapy with anti- IgE or anti-IL5.

[1]  N. Scichilone,et al.  Fifteen-year mortality of patients with asthma-COPD overlap syndrome. , 2016, European journal of internal medicine.

[2]  P. Gibson,et al.  Omalizumab Treatment Response in a Population With Severe Allergic Asthma and Overlapping COPD , 2017, Chest.

[3]  I. Pavord,et al.  Blood eosinophil counts, exacerbations, and response to the addition of inhaled fluticasone furoate to vilanterol in patients with chronic obstructive pulmonary disease: a secondary analysis of data from two parallel randomised controlled trials. , 2015, The Lancet. Respiratory medicine.

[4]  I. Pavord,et al.  Eosinophilic airway inflammation and exacerbations of COPD: a randomised controlled trial , 2007, European Respiratory Journal.

[5]  B. Nordestgaard,et al.  Blood Eosinophils and Exacerbations in Chronic Obstructive Pulmonary Disease. The Copenhagen General Population Study. , 2016, American journal of respiratory and critical care medicine.

[6]  Christopher E Brightling,et al.  Blood eosinophils to direct corticosteroid treatment of exacerbations of chronic obstructive pulmonary disease: a randomized placebo-controlled trial. , 2012, American journal of respiratory and critical care medicine.

[7]  I. Pavord.  Biologics and chronic obstructive pulmonary disease , 2018, The Journal of allergy and clinical immunology.

[8]  S. Uh,et al.  Asthma-COPD Overlap Shows Favorable Clinical Outcomes Compared to Pure COPD in a Korean COPD Cohort , 2017, Allergy, asthma & immunology research.

[9]  I. Pavord,et al.  Mepolizumab for Eosinophilic Chronic Obstructive Pulmonary Disease , 2017, The New England journal of medicine.

[10]  E. Bel,et al.  New Anti‐Eosinophil Drugs for Asthma and COPD: Targeting the Trait! , 2017, Chest.

[11]  R. Lutter,et al.  External validation of blood eosinophils, FENO and serum periostin as surrogates for sputum eosinophils in asthma , 2014, Thorax.

[12]  Diagnostic Criteria for the Asthma-COPD Overlap (ACO) Still Room for Improvement , 2017 .

[13]  R. Barr,et al.  Sputum or blood eosinophil association with clinical measures of COPD severity in the SPIROMICS cohort , 2018 .

[14]  M. Miravitlles,et al.  Is a previous diagnosis of asthma a reliable criterion for asthma–COPD overlap syndrome in a patient with COPD? , 2015, International journal of chronic obstructive pulmonary disease.

[15]  V. Peinado,et al.  Pulmonary hypertension in chronic obstructive pulmonary disease , 2003, European Respiratory Journal.

[16]  Dave Singh,et al.  Eosinophilic inflammation in COPD: prevalence and clinical characteristics , 2014, European Respiratory Journal.

[17]  D. Price,et al.  What is asthma−COPD overlap syndrome? Towards a consensus definition from a round table discussion , 2016, European Respiratory Journal.

[18]  F. Maltais,et al.  Stable COPD: predicting benefit from high-dose inhaled corticosteroid treatment , 2006, European Respiratory Journal.

[19]  J. Donohue,et al.  Characterization of airway inflammation in patients with COPD using fractional exhaled nitric oxide levels: a pilot study , 2014, International journal of chronic obstructive pulmonary disease.

[20]  M. Miravitlles,et al.  Algorithm for identification of asthma–COPD overlap: consensus between the Spanish COPD and asthma guidelines , 2017, European Respiratory Journal.

[21]  C. Xie,et al.  Importance of fractional exhaled nitric oxide in the differentiation of asthma–COPD overlap syndrome, asthma, and COPD , 2016, International journal of chronic obstructive pulmonary disease.

[22]  A. Vanasse,et al.  Eosinophils in COPD Exacerbations Are Associated With Increased Readmissions , 2017, Chest.

[23]  A. Chaouat,et al.  Pulmonary hypertension in COPD: epidemiology, significance, and management: pulmonary vascular disease: the global perspective. , 2010, Chest.

[24]  I. Pavord,et al.  Eosinophils in COPD: just another biomarker? , 2017, The Lancet. Respiratory medicine.

[25]  M. Henket,et al.  Distribution of sputum cellular phenotype in a large asthma cohort: predicting factors for eosinophilic vs neutrophilic inflammation , 2013, BMC Pulmonary Medicine.

[26]  L. Fabbri,et al.  Airways obstruction, chronic expectoration, and rapid decline of FEV1 in smokers are associated with increased levels of sputum neutrophils. , 1996, Thorax.

[27]  D. Sin.  Asthma-COPD Overlap Syndrome: What We Know and What We Don't , 2016, Tuberculosis and respiratory diseases.