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+/-3.5kg/m(2), FEV1 of 0.61+/-0.2L (21.1+/-5.6% pred), pO2 52.4+/-8.4mmHg, 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 >200ml despite maximal therapy, 33% (15/45) had FENO >/=22.5ppb, 33% (24/73) had serum IgE >/=100 I.E./ml and there was positive allergen sensitization in 51.5% (35/68). Blood eosinophilia of >/=150cells/mul 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.
- Matthes, S.
- Stadler, J.
- Barton, J.
- Leuschner, G.
- Munker, D.
- Arnold, P.
- Villena-Hermoza, H.
- Frankenberger, M.
- Probst, P.
- Koch, A.
- Kneidinger, N.
- Milger, K.
- Behr, J.
- Neurohr, C.
Keywords
- Asthma and COPD overlap
- Copd
- Exacerbations of COPD
- Targeted therapy
