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. 2025 May 23;25(1):260.
doi: 10.1186/s12890-025-03731-9.

Clinical characteristic of patients with COPD-A

Jong Min Lee  1 , Youlim Kim  2 , Joon Young Choi  3 , Seung Won Ra  4 , Deog Kyeom Kim  5 , Tae-Hyung Kim  6 , Hyung Kyu Yoon  7 , Kwang Ha Yoo  2 , Ki-Suck Jung  8 , Chin Kook Rhee  9
Affiliations

Clinical characteristic of patients with COPD-A

Jong Min Lee et al. BMC Pulm Med. .

Abstract

Background: The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) document proposed the COPD-A subtype as a condition of COPD with asthma. We examined the characteristics of COPD-A patients and analyzed them according to smoking history and inhaled corticosteroid (ICS) use.

Methods: Patients in the COPD cohort with a history of asthma were included. The patients were divided into two groups according to their smoking history (< 10 vs. ≥10 pack-years) and their clinical characteristics were compared. The association between patients' ICS use and the occurrence for exacerbations during 1 year follow-up period was analyzed.

Results: Of the 970 patients included in the analysis, the group with a smoking history less than 10 pack-years (n = 158) had a significantly higher BMI, FEV1 (%), FEV1/FVC (%), DLco, ESR, and prevalence of osteoporosis. Among 560 patients who were followed up for 1 year, the patients with ICS (n = 274) had a higher exacerbation rate than without ICS (n = 286) (54% vs. 44.1%, p = 0.018). However, in multivariable analysis, ICS use was not significantly associated with exacerbation. In subgroup analysis of patients with blood eosinophil count ≥ 300 cells/µl, ICS use showed a trend to reduce the risk for exacerbation (IRR = 0.907, p = 0.708). In patients with blood eosinophil count < 300 cells/µl, ICS use significantly increased the risk for exacerbation (IRR = 1.547, p = 0.005).

Conclusions: COPD-A patients with a smoking history of less than 10 pack-years had better pulmonary function test results, BMI, ESR, and prevalence of osteoporosis. The use of ICS did not decrease exacerbations in COPD-A.

Keywords: COPD-A; Exacerbation; Inhaled corticosteroid; Smoking.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study protocol was approved by the Institutional Review Board of KONKUK university medical center and all participants in the cohorts provided written informed consent (IRB No. KHH1010338). All hospitals involved in the KOCOSS cohort obtained approval from the Institutional Review Board Committee and informed consent from their patients. Consent for publication: No applicable. Competing interests: CK Rhee received consulting/lecture fees from MSD, AstraZeneca, GSK, Novartis, Takeda, Mundipharma, Boehringer-Ingelheim, Teva, Sanofi, and Bayer.

Figures

Fig. 1
Fig. 1
Flowchart of the included participants. Analysis 1 included 970 patients; Analysis 2 included 560 patients. COPD, chronic obstructive pulmonary disease; KOCOSS, Korean COPD subgroup study; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; mMRC, modified medical research council; CAT, COPD assessment test; SGRQ-C, St. George’s respiratory questionnaire for COPD patients; HTN, hypertension; DM, diabetes mellitus; ICS, inhaled corticosteroid
Fig. 2
Fig. 2
Comparison of the exacerbation rate based on ICS use in COPD-A patients (Analysis 2). Moderate exacerbation was defined as worsening of respiratory symptoms requiring outpatient treatment with antibiotics or steroids. Severe exacerbation was defined as worsening of respiratory symptoms requiring emergency department treatment or hospitalization. ICS, inhaled corticosteroid; *p < 0.05
Fig. 3
Fig. 3
Subgroup analysis based on eosinophil counts. The association between ICS use and exacerbation risk in each subgroup stratified by blood eosinophil count was analyzed using negative binomial regression. BEC, blood eosinophil count; IRR, incident rate ratio
See this image and copyright information in PMC

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