<h2>COPD Exacerbation risk has been shown to accelerate after each exacerbation.2,a&nbsp;</h2>
<h3>Exacerbation risk accelerates after each exacerbation1</h3>

*Severe exacerbations were defined as those which resulted in hospitalization with a primary discharge diagnosis of COPD2
<h3>Despite triple inhaled therapyc, the current standard of care, many patients remain symptomatic as defined by persistent symptoms and exacerbations.</h3>

<h2>Listen to Prof&nbsp;Nicola Hanania: “Prevention of exacerbations is the key goal”</h2>

2:07 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.

CHRONIC-OBSTRUCTIVE-PULMONARY-DISEASE-(COPD)

The Impact of Exacerbations in COPD

Listen to the whole episode of the podcast on the <a href="https://www.emjreviews.com/respiratory/podcasts/the-negative-impact-of-chronic-inflammation-on-quality-of-life-in-patients-with-copd/">EMJ website</a> 
 Sponsored by Sanofi and Regeneron, in partnership with EMJ.

COPD unfortunately is a chronic disease as the name implies. So, it’s a progressive disease. While we cannot cure it, we can manage it, we can treat it. Unfortunately, there are several events in the course of the disease that makes it worse, not only for the patient but for the healthcare system: it increases risk of hospitalization, mortality… And one of them is exacerbations. I call it “lung attacks”. Pretty much what happens with exacerbations is these patients who have daily symptoms become having more symptoms, they may have more cough, increasing sputum production, sometimes these exacerbations are driven by infections – most of the time actually – and they end up needing more and more treatments including antibiotics, steroids. And sometimes unfortunately may end up pushing the patient to go to emergency department or getting hospitalized. Unfortunately, exacerbations is not just the fact that they occur and we can treat them, it’s every time the patient gets an exacerbation it puts his or her lung function down. In fact, there has been good data now to show that repeated exacerbations can contribute to increase risk of worsening exacerbations subsequently, but worsening lung function over long time, and they don’t recuperate lung function, so, meaning every time they get an exacerbation it puts them down both the lung function and the quality of life. There is definitely good data to show that repeated exacerbations have been linked to increased mortality and so on. So that’s why one of the major goals in managing this disease is try to prevent these lung attacks from occurring. Prevention of exacerbations is the key goal in managing this disease. Naturally exacerbations tend to be more frequent in those patients with more severe disease. But they can occur even in moderate COPD as well, in some situations.

Read podcast transcript

<h2>COPD Exacerbations may lead to accelerated lung function decline3,e</h2>

<ul>
 <li>
 Loss of lung function nearly doubled3</li>
 <li>
 Irreversible lung function decline may occur after only one COPD exacerbation3</li>
</ul>
&nbsp;&nbsp;

&nbsp;
aBased on data from a large population-based cohort of 73,106 Canadian patients (mean age 75 years) who were hospitalized for the first time because of a severe exacerbation of COPD (1990-2005, followed until death or March 31, 2007).2 bAdjusted for age, sex, calendar time, and the modified Chronic Disease Score.2 cOr double inhaled therapy if ICS is contraindicated.15 d52-week, randomized, double-blind, phase 3 trial that assessed the efficacy and safety of fluticasone furoate/umeclidinium/vilanterol triple therapy versus fluticasone furoate/vilanterol or umeclidinium/vilanterol in patients aged ≥40 years with symptomatic COPD and a history of exacerbations.2 eFEV1 decline after a single moderate-to-severe exacerbation. Based on a retrospective analysis of data from 586 patients with moderate-to-severe COPD.5&nbsp; 
 aHR, adjusted hazard ratio; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 second; QoL, quality of life&nbsp;

<h2>Type 2 Inflammation may increase the risk of exacerbations and lung function impairment in COPD23,24</h2>
<h3>COPD is characterized by mucus production, airway obstruction, and coughing13</h3>

<h3>Inflammation manifests systemically and locally</h3>

<ul>
 <li>Chronic inflammation causes structural changes, including narrowing of the airways and decreased lung elasticity13</li>
 <li>Studies have identified a relationship between inflammation and mucus hypersecretion in respiratory conditions such as COPD25</li>
</ul>
&nbsp;&nbsp;

<h2>Listen to Prof Nicola Hanania : “We no longer look at it as a one-size-fits-all disease”</h2>

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.

Role of type 2 Inflammation 

I think our approach to this all disease has changed, knowing that it has multiple what we call phenotypes, but also not only that, but we have identified multiple mechanism of the disease, so we no longer look at it as a one-size-fits-all disease. And so therefore it's very important for clinician to do some really digging deep into history to identify these phenotypes, whether it's a frequent exacerbative phenotype, whether it's a chronic bronchitic phenotype, whether it's an emphysema mainly phenotype, but now we use biomarkers like blood eosinophils and maybe more to come, including radiology biomarkers in the future, may help us subdivide this group of patients so that we can do a more personalized approach. And I think it's very exciting time for COPD, so we have moved from this blue-bloater pink puffer type approach to now having multiple, as I mentioned, subtypes or phenotypes, and including the identifying more mechanism so that we have more targeted approach to this disease. And hopefully that will help improve outcomes in the future, obviously. That's the main goal is to move that increased risk of mortality that we have seen in COPD, while we have seen so much achievement with other diseases in COPD. Unfortunately, we haven't moved that envelope a lot, so I think we're hoping with new approaches we may improve outcomes.

<h2>Look for elevated blood eosinophils (&gt;300 Cells/Lμ) - A Biomarker of Type 2 Inflammation in COPD13</h2>

<h4>&nbsp;</h4>
<h3>Elevated eosinophils in COPD are a treatable trait and marker of type 2 inflammation13</h3>
The 2024 GOLD Report recognizes elevated blood EOS as a clinically used biomarker in identifying COPD with type 2 inflammation
<h2>Type 2 inflammation in COPD can involve multiple pathways, cytokines, and inflammatory cells28-33</h2>

<h2>IL-4, IL-13, an IL-5 are type 2 cytokines involved in COPD</h2>

&nbsp;&nbsp;
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 &gt;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 &lt;0.7, with FEV, &gt;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.

<h2>The SGRQ measures the qualitative impact of COPD14,a</h2>
Some domains evaluated by the SGRQ include16:

Cough

Sputum production

Breathlessness

Wheezing

Exacerbations

Work activities

Daily activities*

Medication use

*Such as walking upstairs or getting dressed.
<h3>E-RS-COPD assess COPD symptomsb</h3>
Some domains evaluated by the E-RS-COPD include16:

Cough

Breathlessness

Chest congestion

This is not an exhaustive list of items evaluated by the SGRQ and E-RS-COPD.
&nbsp;
<h2>Listen to Prof Claus Vogelmeier : "We are now starting to characterize patients more carefully"</h2>

0:37 minutes
Claus Vogelmeier is Professor of Medicine and Head of the Department of Pneumology at the University Hospital Marburg, Germany

Quality of life and symptom measurement in COPD Patients

Listen to the whole episode of the podcast on the <a href="https://www.emjreviews.com/respiratory/podcasts/the-negative-impact-of-chronic-inflammation-on-quality-of-life-in-patients-with-copd/" target="_blank">EMJ website</a> 
 Sponsored by Sanofi and Regeneron, in partnership with EMJ.

We are now starting to characterize patients more carefully. We have to get to a better understanding what patients will profit (meaning = benefit) from what kind of treatment. This is just at the starting point from my perspective, and what we already know is that patients at (meaning = who) exacerbate need different treatment compared to patients that do not exacerbate. But there is still a lot to learn, and only if we can characterize patients more carefully, and we also have to identify the so-called treatable traits. So we have to look for features that may have therapeutic consequences.

&nbsp;
a The SGRQ is a 50-item questionnaire designed to measure the qualitative impact of COPD on overall health , daily life, and perceived well-being. Higher scores mean greater disease severity. 14 b E-RS-COPD is an 11-item patient-reported derivative tool that measures the effect of treatment on respiratory symptom severity in patients with stable COPD . Higher scores mean greater disease severity. 17
 
  COPD, chronic obstructive pulmonary disease; E-RS-COPD, Evaluating Respiratory Symptoms in COPD; QoL, quality of life; SGRQ, St George’s Respiratory Questionnaire

What if you could identify higher-risk patients?&nbsp;&nbsp;
A deeper look at the inflammation behind exacerbations could ignite new thinking in COPD. Look for blood eosinophils, a biomarker of COPD with Type 2 Inflammation, which may help you identify those patients at increased risk of exacerbations.
Watch the video below to better understand exacerbations in COPD and better identify patients at risk.&nbsp;&nbsp;&nbsp;

Understanding type 2 inflammation may help shed light on why some patients continue to exacerbate. Watch this video to learn how.

One minute to ignite new thinking in COPD

Ignite new thinking in COPD -&nbsp;COPD, chronic obstructive pulmonary disease
In patients with COPD, exacerbations may :&nbsp;
<ul>
 <li>Increase the risk of another&nbsp;1</li>
 <li>Accelerate lung function decline&nbsp;2</li>
 <li>Increase morbidity and mortality risk&nbsp;1,3-6</li>
</ul>
Different types of chronic inflammation have an important role in COPD&nbsp;7-15 
 Type 2 inflammation and beyond type 2 inflammation 
 Identifying COPD patients with type 2 inflammation may help determine those at increased risk of exacerbations 16 
 Look for blood eosinophils, a biomarker of COPD with type 2 inflammation 17,18, a, b 
 EOS ≥ 300 cells/ μL à 32% increased risk of COPD exacerbations 16a,b 
 Understanding type 2 inflammation in COPD may shed light on why some patients continue to experience exacerbations
a Results from an observational analysis of 1553 patients with GOLD spirometry grade 2-4 COPD evaluating the relationship between blood eosinophil count and COPD exacerbation risk. b Stratified analysis confirmed that increased exacerbation risk was driven by subjects with a history of frequent exacerbations, defined as ≥2 exacerbations per year.

Read video transcript

Understanding type 2 inflammation may help shed light on why some patients continue to exacerbate. Watch this video to learn how.

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Latest Articles

The Impact of Exacerbations in COPD

Role of type 2 Inflammation

Quality of life and symptom measurement in COPD Patients

One minute to ignite new thinking in COPD