A cell with pink background
Up to ~40% of patients with COPD may have type 2 inflammation

Type 2 Inflammation may increase the risk of exacerbations and lung function impairment in COPD23,24

COPD is characterized by mucus production, airway obstruction, and coughing13

Mucus hypersecretion and Alveolar wall destruction

Inflammation manifests systemically and locally

Elevated blood eosinophils are associated with 1.76x greater risk for a severe COPD exacerbation
Localized Inflammation : Illustration representing  mucus in control next to illustration representing mucus in COPD
  • Chronic inflammation causes structural changes, including narrowing of the airways and decreased lung elasticity13
  • Studies have identified a relationship between inflammation and mucus hypersecretion in respiratory conditions such as COPD25


Identifying type 2 inflammation may help you discover at-risk patients.

Listen to Prof Nicola Hanania : “We no longer look at it as a one-size-fits-all disease”

1:36 minutes

Nicola Hanania is Professor of Medicine, Section Chief of Pulmonary Critical Care and Sleep Medicine at the Ben Taub Hospital in Houston, Texas, and Director of the Airways Clinical Research Center, ACRC, at the Bear College of Medicine.

Listen to the whole episode of the podcast on the EMJ website
Sponsored by Sanofi and Regeneron, in partnership with EMJ.

Look for elevated blood eosinophils (>300 Cells/Lμ) - A Biomarker of Type 2 Inflammation in COPD13

If Blood eosinophils > 300 cells/microL, 32% increased risk of exacerbations and 99% increased risk of rehospitalization


Elevated eosinophils in COPD are a treatable trait and marker of type 2 inflammation13

The 2024 GOLD Report recognizes elevated blood EOS as a clinically used biomarker in identifying COPD with type 2 inflammation

Type 2 inflammation in COPD can involve multiple pathways, cytokines, and inflammatory cells28-33

pathway due to inflammation

IL-4, IL-13, an IL-5 are type 2 cytokines involved in COPD

IL-4 and IL-13 promote the activation and trafficking of type-2 inflammatory cells, including eosinophils, to the lungs.
IL-13 plays a role in emphysema, fibrosis, and goblet cell hyperplasia and increases expression of MUC5AC
Illustration of the causes of the  airflow obstruction


Understanding type 2 inflammation in COPD may help shed light on why some patients continue to experience exacerbations.


aBased on findings from 5 studies in COPD patients without asthma. Eosinophil levels used to define type 2 inflammation ranged from ≥300 cells/μL to ≥340 cells/μL (blood), ≥2% in induced sputum or 3% in peripheral blood. Percentages of patients with type 2 inflammation ranged from 12.3% to ~40%23,24
bA severe exacerbation was defined as a hospitalization due to COPD. Exacerbations had to be a minimum of 4 weeks apart to be considered separate exacerbations.27
cIn a cohort of patients with EOS >200 cells/μL.26
dReproduced with permission of the American Thoracic Society. Fritzsching B et al. Am J Respir Crit Care Med. 2015;191(8):902-91325
eAlcian blue PAS staining of mucus in airway epithelial cells.25
fResults from an observational study of 1553 patients with GOLD spirometry grade 2-4 COPD (postbronchodilator FEV1/FVC ratio <0.7, with FEV, >80% predicted)23
gResults from a 1-year observational study of 479 patients with COPD, 173 of whom had blood eosinophil levels ≥200 cells/μL and/or ≥2% of the total white blood cell count.24

COPD, chronic obstructive pulmonary disease; EOS, eosinophils; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; IFN-y, interferon-gamma; ILC2, innate lymphoid type-2 cells; MUC5AC, mucin 5AC; PAS, periodic acid-Schiff; TNF-a, tumor necrosis factor alpha; TSLP, thymic stromal lymphopoietin.


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MAT-BH-2400291/V1/May/2024Last Update: 05/2024