Effect of allergic phenotype on treatment response to inhaled bronchodilators with or without inhaled corticosteroids in patients with COPD

Figures & data

Table 1 Baseline demographic characteristics of study subjects with COPD

	HEE (n=85)	HEO (n=51)	HIE (n=47)	LEE (n=121)	P-value
Age, year (mean ± SD)	64.3±18.1	69.5±19.9	67.8±18.5	68.2±21.6	0.136
Sex					0.582
Male	79 (92.9%)	47 (92.2%)	45 (95.7%)	111 (91.7%)
Female	6 (7.1%)	4 (7.8%)	2 (4.3%)	9 (7.4%)
Smoking, pack-years (mean ± SD)	25.1±14.7	26.6±19.5	24.7±15.4	26.2±20.2	0.481
Acute exacerbation (>1 admission)	16 (18.8%)	7 (13.7%)	6 (12.8%)	13 (10.7%)	0.043*
Lung function test
Bronchodilator test respond (+)	11 (14.8%)	6 (11.8%)	6 (12.8%)	14 (11.6%)	0.144
GOLD I (%)	6 (7.1)	5 (9.8)	5 (10.6)	17 (14.0)	0.078
GOLD II (%)	41 (48.2)	24 (47.1)	22 (46.8)	59 (48.8)
GOLD III (%)	22 (25.9)	17 (33.3)	14 (29.8)	38 (31.4)
GOLD IV (%)	16 (18.8)	5 (9.8)	6 (12.8)	7 (5.8)
Group A (%)	5 (5.9)	7 (13.7)	5 (10.6)	20 (16.5)	0.06
Group B (%)	37 (43.5)	22 (43.1)	19 (40.4)	61 (50.4)
Group C (%)	25 (29.4)	18 (35.3)	19 (40.4)	32 (26.4)
Group D (%)	18 (21.1)	4 (7.8)	4 (8.5)	8 (6.6)
FEV1 (L) (% of predicted)	1.24±0.18 (48.7)	1.28±0.21 (52.5)	1.37±0.19 (58.9)	1.35±0.24 (56.2)	0.117
FVC (L) (% of predicted)	2.19±0.42 (49.5)	2.29±0.52 (53.8)	2.40±0.45 (60.6)	2.46±0.51 (62.7)	0.066
FEV1/FVC (% of predicted)	50.2±20.3	49.4±22.9	51.9±18.1	51.6±19.4	0.273
FEV1 reversibility (%)	6.2±5.5	8.4±5.9	6.3±5.8	7.1±6.4	0.391
CAT baseline	17±9	14±10	14±9	18±9	0.529
Medications
LABA (%)	11 (12.9)	5 (9.8)	6 (12.8)	18 (14.9)	0.214
LAMA (%)	19 (22.3)	15 (29.4)	13 (27.7)	32 (26.4)
LABA/LAMA (%)	20 (23.5)	12 (23.5)	14 (29.8)	29 (23.9)
ICS/LABA (%)	14 (16.5)	6 (11.8)	7 (14.8)	19 (15.7)
ICS/LABA/LAMA (%)	21 (24.7)	13 (25.5)	7 (14.8)	23 (19.0)
Comorbidity
Hypertension (%)	33 (39.2)	19 (37.2)	17 (36.2)	47 (38.8)	0.113
Diabetes mellitus (%)	14 (16.5)	9 (17.6)	10 (21.2)	17 (14.0)
Coronary artery disease (%)	9 (10.6)	8 (15.7)	4 (8.5)	14 (11.6)
Congestive heart failure (%)	11 (12.9)	6 (11.8)	7 (14.9)	20 (16.5)

Notes: Continuous variables are presented as mean ± SD; categorical variables are presented as numbers and percentages.

* Significant difference between the four groups: P<0.05.

Abbreviations: CAT, COPD Assessment Test; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; HEE, higher eosinophil count and IgE levels; HEO, higher eosinophil count; HIE, higher IgE level; ICS, inhaled corticosteroids; LABA, long-acting β-agonist; LAMA, long-acting muscarinic antagonist; LEE, lower eosinophil count and IgE level; SD, standard deviation.

Table 2 Treatment effectiveness in COPD patients with allergic phenotypes

	HEE (n=85)	P-value	HEO (n=51)	P-value	HIE (n=47)	P-value
Lung function FEV1 (mL)		<0.008*		0.072		0.129
ICS-based therapy†	132.4±28.8		115.5±30.9		119.8±31.4
BD-based therapy†	85.7±24.2		96.1±28.7		97.4±32.7
Lung function FVC (mL)		<0.007*		0.141		0.352
ICS-based therapy	141.1±39.6		119.9±42.3		123.8±40.7
BD-based therapy	105.8±41.7		124.6±39.7		126.6±44.1
COPD Assessment Test		0.042*		0.032*		0.416
ICS-based therapy	8±5		7±6		9±7
BD-based therapy	12±7		13±9		11±8
Acute exacerbation (>.1 hospitalization)		<0.008*		0.245		0.475
ICS-based therapy	10 (11.7%)		7 (13.6%)		6 (13.4%)
BD-based therapy	21 (24.1%)		10 (19.8%)		10 (20.3%)

Notes: Continuous variables are presented as mean ± SD; categorical variables are presented as numbers and percentages.

* Significant difference between ICS- and BD-based treatment within a given group, P<0.05.

† ICS-based therapy including ICS/LABA or ICS/LABA/LAMA; BD-based therapy including LABA; LAMA or LABA/LAMA.

Abbreviations: BD, bronchodilator; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; HEE, higher eosinophil count and IgE level; HEO, higher eosinophil count; HIE, higher IgE level; ICS, inhaled corticosteroids; LABA, long-acting β-agonist; LAMA, long-acting muscarinic antagonist.

Figure 1 ROC curves for eosinophil + IgE, IgE, eosinophil, and LEE in patients with chronic obstructive pulmonary disease.

Abbreviations: eosino, eosinophil; IgE, immunoglobulin E; LEE, lower eosinophil and IgE group; ROC, receiver operating characteristic.

Figure 2 Chronic obstructive pulmonary disease treatment strategy, including lung function, symptoms, serum biomarkers, phenotypes, and comorbidities.

Abbreviations: ACOS, asthma-COPD overlap syndrome; AE, acute exacerbation; BCOS, bronchiectasis-COPD overlay syndrome; CAT, COPD Assessment Test; CVD, cardiovascular disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroids; IgE, immunoglobulin E; LABA, long-acting β-agonist; LAMA, long-acting muscarinic antagonist; mMRC, modified Medical Research Council; NAC, N-acetylcysteine.