Patients with Chronic Obstructive Pulmonary Disease and Evidence of Eosinophilic Inflammation Experience Exacerbations Despite Receiving Maximal Inhaled Maintenance Therapy

Stephanie Chen, Marc Miravitlles, Chin Kook Rhee, Ian D. Pavord, Rupert Jones, Victoria Carter, Benjamin Emmanuel, Marianna Alacqua, David Price* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Background: Some patients with chronic obstructive pulmonary disease (COPD) experience frequent exacerbations despite maximal inhaled therapy (“triple therapy”), possibly leading to high health care resource utilization (HCRU).
Aims: Describe characteristics, future HCRU, and mortality of patients with COPD who experience frequent exacerbations despite triple therapy; characterize individuals who may be candidates for biologic therapies.
Methods: This descriptive observational study used primary care data of patients aged ≥40 years in the United Kingdom receiving maintenance therapy for COPD who had ≥1 year of data prior to index date and 1 year of follow-up data. We described these patients’ clinical and demographic characteristics, including blood eosinophil counts (BEC), pattern of exacerbations, hospitalizations, and corticosteroid exposure, as well as future exacerbations, hospitalizations, and death.
Results: Of 43,753 patients with maintenance-treated COPD, 6480 experienced exacerbations despite ≥3 months of triple therapy. Of these, 5669 had available BEC: 1287 (22.7%) had BEC ≥250 cells/µL and ≥3 exacerbations in the year prior to the index date; 471 (36.6%) received ≥4 acute courses of oral corticosteroids. Patients with a pattern of high disease burden continued to have high disease burden: 51.1% experienced ≥3 exacerbations and 2.6% experienced ≥3 hospitalizations. Patients who experienced exacerbations despite triple therapy had a significantly higher risk of COPD-related death than other maintenance-treated patients (5.8% vs. 2.1%).
Conclusions: Nearly one-quarter of patients receiving triple therapy for COPD who experienced frequent exacerbations had elevated BEC, suggesting a potential mechanism of persistent eosinophilic inflammation that could be a target for eosinophil-depleting biologic therapy.
Original languageEnglish
Pages (from-to)2187—2200
Number of pages14
JournalInternational journal of chronic obstructive pulmonary disease
Issue number17
Early online date9 Sept 2022
Publication statusPublished - 9 Sept 2022

Bibliographical note

This work uses data provided by patients and collected by the National Health Service as part of their care and support. Medical writing and editorial support were provided by Jennifer Gibson, PharmD, and Leonard Lionnet, PhD, of Kay Square Scientific, LLC. This support was funded by AstraZeneca.

This study was funded by AstraZeneca.

Data Availability Statement

Data underlying the findings described in this manuscript may be requested in accordance with AstraZeneca’s data-sharing policy described at


  • chronic obstructive pulmonary disease
  • disease burden
  • eosinophils
  • exacerbations
  • health care resource utilization


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