Frequent exacerbations, Asthma-COPD overlap (ACO) and emphysema phenotype characteristics in COPD real-world outpatients

<bold>Objective:</bold> The STEP real world study described treatment adaptations (step-up, step-down or switch) and patient characteristics in Austrian COPD outpatients. The focus in this analysis is on COPD phenotypes of frequent exacerbator, ACO and emphysema. <bold>Methods:</bold> Of all STEP patients, those with the only phenotype of “frequent exacerbator” (>2 exacerbations/year), “ACO” or “emphysema” were compared by demographics, lung function, CAT score and treatment adaptation using ANOVA for metric and Chi-square tests for categorical variables. <bold>Results:</bold> Of 1137 STEP Patients, 109, 90 and 267 patients (41% of all patients) were classified as exclusive phenotypes for „frequent exacerbator“, „ACO“ or „emphysema“. <bold>Significant</bold> differences include a higher BMI (28,4+6 vs. 25,5+5,1) in frequent exacerbator compared to emphysema patients. ACO patients had better FEV1 results compared to frequent exacerbator and emphysema patients (62,7%+17,6 vs. 49,2%+15,3 and 53,6%+17,7). Symptom burden (CAT) was worst in frequent exacerbator vs. ACO and emphysema patients (21,8+6,6 vs. 16,6+7,5 and 18,1+7,8). While 78% of frequent exacerbator patients had any step-up of treatment (2,8% step-down), 58,9% of ACO and 55,4% of emphysema patient received step-up of therapy (step-down: 14,4% and 17,23%, respectively). 86,2% (frequent exacerbator), 80% (ACO) and 56,6% (emphysema) patients received an ICS-containing therapy after adaptation. Adaptations by treatment classes are presented in Sankey plots. <bold>Conclusion:</bold> There are important clinical differences among phenotypes in Austrian COPD outpatients. These differences may alter treatment adaptations and underscore the importance of targeted disease management.