Markers of T2-inflammation in patients with severe asthma and concomitant COPD

The aim of this study was to assess the biomarkers of T2-inflammation in patients with severe asthma with or without concomitant COPD. Methods: We examined 97 outpatients (34% male, aged 18-78 yr, mean age 55 yrs) with severe uncontrolled asthma (mean ACQ5 2.51) according to ERS/ATS (2014) definition treated with high dose of ICS/LABA±tiotropium. Some patients (n=31) had concomitant COPD. Blood eosinophils (Eos) were measured by automatic haemoanalyser. Atopic status was assessed by positive skin prick-test or serum specific IgE to common inhalant allergens. FeNO was measured by a chemiluminescence analyzer (LR4000;UK). Presence of allergy, need for regular oral steroid use, Eos≥150 cell/μl and FeNO≥20 ppb were considered as markers of T2-inflammation. Results: Patients with severe asthma and concomitant COPD were more frequently males (52% vs 28%, p<0.05) with shorter duration of asthma (11 vs 18 yrs, p<0.05), current smokers (65% vs 9%, p<0.001) with higher pack-years of smoking (38 vs 19, p<0.01) and lower FEV1 pred (45% vs 55%, p<0.05) compared to those without COPD. Prevalence of atopy (68% vs 76%, p>0.05), steroid-dependent (17% vs 15%, p>0.05) or aspirin-induced asthma (10% vs 11%, p>0.05) were similar in two groups. In patients with severe asthma with or without COPD level of Eos was 307 vs 415 cell/μl (p>0.05) whereas FeNO was 20 vs 37 ppb (p<0.05). At least one of 4 markers of T2-inflammation was elevated in 90% vs 95% (p>0.05) of severe asthmatics with or without COPD. Conclusion: The majority of patients with severe asthma regardless of concomitant COPD have at least one or more elevated markers of T2-inflammation, except of FeNO. Eos≥150 cell/μl and allergy were the most frequent markers.