Abstract Rationale Type 2 inflammation, identified by biomarkers including elevated blood eosinophil count (BEC) 300 cells/µL or elevated Fractional Exhaled Nitric Oxide (FeNO), may drive COPD symptoms and exacerbations. Dupilumab, as an add-on to standard triple therapy, has been shown to reduce the annual rate of COPD exacerbations. FDA, EMA, and GOLD 2025 guidelines recommend considering Dupilumab in COPD with BEC ≥300/µL. Dupilumab is not currently reimbursed for COPD in Ireland. We reviewed the Type 2 Inflammation status of a cohort of patients with recurrent unscheduled admissions to hospital with COPD exacerbations, to estimate what proportion might meet indications for Dupilumab, and their associated inpatient healthcare utilisation. National Health Pricing data estimates an average COPD admission cost in the ROI at EUR∼7000. Methods We performed a retrospective review of adults admitted with a primary COPD diagnosis on ≥ 2 occasions between January-December 2023 at a single tertiary academic teaching centre in Dublin, Ireland. Data extracted included admission data (count and length of stay), BEC at presentation, maximum outpatient BEC in the preceding year, and the highest ever recorded BEC outside of inpatient stays. Spirometry data, prior bronchodilator response (BDR), FeNO were also recorded. Results 93 patients accounted for 241 admissions, with an average admission-specific LOS of 10 days. Only 61/93 (65.6%) had availble spirometry, and of those, 52/61 confirmed obstructive spirometry (52/93, 55.9% of the total cohort). Of the 52 patients with confirmed obstructive spirometry, BDR was positive in 7 (13.5%), negative in 6 (11.5%) and not tested in 39 (75%). FeNO was available in 2 patients (3.8%), both 25ppb. BEC was ≥300/µL at presentation with an acute exacerbation for 14 of the 52 patients with confirmed COPD (26.9%). However, in the year prior to the exacerbation, 35/52 (67.3%) had BEC ≥300/µL in the outpatient setting and 47/52 (90.4%) had historical BEC ≥300/µL. Conclusion Almost a third of patients with an admission diagnosis of COPD had no objective spirometric confirmation. A small proportion had features of an overlap syndrome with asthma as per bronchodilator response criteria. BDR testing and FeNO were underutilized in this cohort. The majority of patients with confirmed COPD had evidence of elevated blood eosinophils in their lifetime, with 67.3% demonstrating an elevated BEC within a year of admission. This suggest a sizeable subgroup may potentially benefit from add-on biologic therapy in the ROI. Given the high admission burden (2.59/patient/year), targeted pathways for eosinophilic COPD may reduce exacerbations and resource use. This abstract is funded by: None
Zaman et al. (Fri,) studied this question.