Sandhya Matthes1, Jakob Stadler2, Jürgen Barton2, Gabriela Leuschner2, Dieter Munker2, Paola Arnold2, Heidrun Villena-Hermoza2, Marion Frankenberger3, Philipp Probst4, Andrea Koch2, Nikolaus Kneidinger2, Katrin Milger2, Jürgen Behr2, Claus Neurohr5. 1. Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany. Electronic address: Sandhya.Matthes@klinik-bethanien.de. 2. Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany. 3. Comprehensive Pneumology Center, Helmholtz Center Munich, Ludwig-Maximilians University Munich and Asklepios Klinik Gauting, Germany. 4. Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Germany. 5. Department of Respiratory and Ventilatory Medicine, Klinik Schillerhöhe, Robert-Koch Hospital, Academic Hospital of the University of Tübingen, Germany.
Abstract
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.
AIM: Biological therapies developed for severe asthma may have a role in COPDpatients 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.