Characteristics of exacerbating COPD patients with productive cough and on inhaled triple therapy, by smoking status: a real-world multi-country study

<bold>Objective:</bold> Describe characteristics and smoking status of patients with COPD who are symptomatic and exacerbating while on inhaled triple therapy (TT). <bold>Methods:</bold> Data were drawn from the 2022 Adelphi COPD Disease Specific Programme™, a cross-sectional survey of 4,372 patients with COPD in France, Italy, Germany, Spain, the UK, China and the US. Between July 2022 and January 2023, physicians completed a comprehensive questionnaire for up to 8 consecutive patients on socio-demographics, comorbidities and COPD-related characteristics. Herein, we described patients with former/current smoking status, productive cough, ≥2 moderate or ≥1 severe exacerbation in the prior year and on TT, overall and by smoking status. <bold>Results:</bold> 399 (9%) were symptomatic/exacerbating and on TT. Mean age was 69 (SD, 9); 288 (72%) were male and 150 (38%) current smokers. Compared to former smokers, current smokers were younger (mean age, 66 vs 71), less likely male (65% vs 76%), had lower eosinophil counts (median, 163 vs 215) and more frequently severe exacerbations (71% vs 66%). Their lung function was higher (mean FEV1, 53% vs 49% predicted - <italic>not statistically different</italic>). Former and current smokers had comparable numbers of exacerbations in the prior year (mean, 2.5 in both groups) and breathlessness (dyspnoea scale score ≥2 in 77% vs 79%). <bold>Conclusions:</bold> Nearly 10% of this international cohort have ongoing COPD symptoms and recurrent exacerbations while on TT. Current smokers tend to be younger with higher lung function but in general current and former smokers show similar disease burden and should therefore benefit from optimized care including smoking cessation.