<a href="${link:{uuid:{d4dafd48-4837-4ef7-ab1b-76db53f754ab},repository:{dam},path:{/Portal/UK/Prescribing-links/Dupixent%20(COPD)%20PI%20GB%20September%202024.pdf}}}" target="_blank">Dupixent (dupilumab) Prescribing Information (GB only)</a>

<h2>Type 2 Inflammation may increase the risk of exacerbations and lung function impairment in COPD6,7</h2>
<h3>COPD is characterised by mucus production, airway obstruction, and coughing8</h3>

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

<ul>
 <li>Chronic inflammation causes structural changes, including narrowing of the airways and decreased lung elasticity8</li>
 <li>Studies have identified a relationship between inflammation and mucus hypersecretion in respiratory conditions such as COPD9</li>
</ul>
&nbsp;&nbsp;

<h2>Look for elevated blood eosinophils&nbsp;- A Biomarker of Type 2 Inflammation in COPD8</h2>

<h4>&nbsp;</h4>
<h3>Elevated eosinophils in COPD are a treatable trait and marker of type 2 inflammation11</h3>
The 2024 GOLD Report recognises elevated blood EOS as a clinically used biomarker in identifying COPD with type 2 inflammation8
<h2>Type 2 inflammation in COPD can involve multiple pathways, cytokines, and inflammatory cells12</h2>

<h2>IL-4, IL-13, and 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%6,7 bA severe exacerbation was defined as a hospitalisation due to COPD. Exacerbations had to be a minimum of 4 weeks apart to be considered separate exacerbations.10 cIn a cohort of patients with EOS &gt;200 cells/μL.9 dReproduced with permission of the American Thoracic Society. Fritzsching B et al. Am J Respir Crit Care Med. 2015;191(8):902-9139 eAlcian blue PAS staining of mucus in airway epithelial cells.9 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)6 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.7 
 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.

Dupixent (dupilumab) Prescribing Information (GB ONLY)

CHRONIC-OBSTRUCTIVE-PULMONARY-DISEASE-(COPD)

Role of type 2 inflammation 

<h2>The SGRQ measures the qualitative impact of COPD1,2</h2>
Some domains evaluated by the SGRQ include1,2:

Cough

Sputum production

Breathlessness

Wheezing

Exacerbations

Work activities

Daily activities*

Medication use

*Such as walking upstairs or getting dressed.
<h2>E-RS:COPD assesses COPD symptoms3,4,b</h2>
Some domains evaluated by the E-RS:COPD include3,4:

Breathlessness

Cough &amp; Sputum&nbsp;

Chest symptoms

Additional Attributes (tired or weak, sleep disturbance, scared or worried)

<h4>This is not an exhaustive list of items evaluated by the SGRQ and E-RS:COPD.</h4>

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.1,2 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. 3,4
 
 COPD, chronic obstructive pulmonary disease; E-RS:COPD, Evaluating Respiratory Symptoms in COPD; QoL, quality of life; SGRQ, St George’s Respiratory Questionnaire

RESPIRATORY

Quality of life and symptom measurement in COPD patients

<h2>COPD exacerbation risk has been shown to accelerate after each exacerbation.2,a&nbsp;</h2>
<h3>Exacerbation risk accelerates after each exacerbation2</h3>

*Severe exacerbations were defined as those which resulted in hospitalisation with a primary discharge diagnosis of COPD2
<h3>Despite triple inhaled therapyc, many patients remain symptomatic as defined by persistent symptoms and exacerbations.2</h3>

<h2>COPD exacerbations may lead to an accelerated rate of decline in lung function3,d</h2>

<ul>
 <li>
 Rate of FEV1 decline nearly double3</li>
 <li>
 Lung function decline may occur after only one COPD exacerbation3</li>
</ul>

aBased on data from a large population-based cohort of 73,106 Canadian patients (mean age 75 years) who were hospitalised for the first time because of a severe exacerbation of COPD (1990-2005, followed until death or March 31, 2007). The hazard functions of successive hospitalised COPD exacerbations and all-cause mortality over time were estimated, and HRs adjusted for age, sex, calendar time and comorbidity.&nbsp;2 bAdjusted for age, sex, calendar time, and the modified Chronic Disease Score.2 cOr double inhaled therapy if ICS is contraindicated.4 dFEV1 decline after a single moderate-to-severe exacerbation. Based on a retrospective analysis of data from 586 patients with moderate-to-severe COPD.3&nbsp; 
 aHR, adjusted hazard ratio; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 second; QoL, quality of life&nbsp;

The impact of exacerbations in COPD

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Role of type 2 inflammation

Quality of life and symptom measurement in COPD patients

The impact of exacerbations in COPD