Clinical characteristics of eosinophilic COPD versus COPD patients with a history of asthma

Abstract

Eosinophilic COPD appears to be a distinct patient subgroup with an increased corticosteroid response. Eosinophilic COPD has been labelled as part of the asthma COPD overlap syndrome (ACOS). We compared the clinical characteristics of eosinophilic COPD patients (without any clinical history of asthma) and COPD patients with a childhood history of asthma. COPD patients with asthma were characterised by more allergies and more exacerbations, but less eosinophilic inflammation. While terms such as “ACOS” are used to “lump” patients together, we report distinct differences between eosinophilic COPD and COPD patients with asthma, and propose that these groups should be split rather than lumped.

Asthma-COPD overlap is not a homogeneous disorder: further supporting data

“…We have read with great interest the letter by Kolsum et al [ 1 ] and we fully agree that eosinophilic COPD (e-COPD) patients have distinct characteristics compared to smoking asthmatics (SA) who develop non-fully reversible airflow obstruction. Both entities are commonly encompassed under an umbrella term [ 2 ], the so-called Asthma-COPD overlap (ACO), but, in the age of personalized medicine [ 3 ], it might be unacceptable to offer the same treatment for two related but different conditions.…”

Predictors of asthma-chronic obstructive pulmonary disease overlap syndrome in patients with chronic obstructive pulmonary disease from a tertiary care center in India

“…Our patients may be a mix of several subphenotypes and that may lead to an absence of statistical significance with respect to AEC. [ 21 22 ] A subgroup analysis also failed to show any significance between ACOS patients with high reversibility and blood AEC levels, again contradicting with literature published elsewhere. [ 23 ] We found pulmonary hypertension to be diagnosed significantly more in the non-ACOS COPD group.…”

The Many Faces of Chronic Obstructive Pulmonary Disease: Moving Towards Precision Medicine

“…Some studies suggest that high count of eosinophils in blood is predictive of favourable response to steroidal and bronchodilator therapies in patients with stable COPD, whereas some other suggest that high eosinophil count in COPD patients does not contribute to exacerbation risk, in-hospital mortality, and length of hospital stay. However, high eosinophil count in the outpatient COPD patients with higher eosinophil count demonstrated an increased risk of exacerbation by 18% 47,48 . Interestingly, consistently in both asthma and COPD, sputum eosinophilia is associated with an excellent response to corticosteroid therapy and strategies aimed to normalise sputum eosinophils reduce exacerbation frequency and severity 51 .…”

“…Eosinophils were also known to get into the lower airways of patients with COPD, but their role was unknown and considered marginal. However, recent studies have shown that increased sputum eosinophils were present in both stable and exacerbation phases of patients with COPD, implying the potential role of eosinophils in the pathogenesis of COPD 47,48 . Eosinophilia is generally defined as greater or equal to 2% eosinophils in either blood or sputum, or an absolute blood eosinophil count of 0.34 × 10 9 cells per litre.…”