Unraveling severe COPD exacerbations: Treatment barriers and unaddressed comorbidities

<bold>Background:</bold> Acute exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) are potentially life-threatening events that accelerate lung function decline and worsen quality of life. Targeted biologics for COPD may alter disease prognosis but necessitate systematic assessments to identify exacerbation triggers and better phenotype this heterogeneous condition. <bold>Aim:</bold> To estimate the prevalence and pattern of treatment barriers, comorbidities, and T2 inflammation among patients hospitalized with severe exacerbating COPD. <bold>Methods:</bold> All patients admitted with AECOPD to Bispebjerg Hospital, Denmark over a 12-month period were invited to participate in the study. Six to 12 weeks after discharge, patients underwent a systematic assessment using a pre-specified protocol. Data on disease phenotype (static and dynamic lung volumes, symptoms, disease control), treatment barriers (inhalations technique, compliance), inflammometry (sputum and blood differential count, FeNO) and comorbidities were collected. <bold>Results:</bold> A total of 103 patients hospitalized with AECOPD were included. Comorbidities were highly prevalent with 87% having ≥ 3, with 28% being unknown or untreated. A critical error in inhalation technique and/or adherence to inhaled medication ≤ 80% of prescribed was identified in 58% of the patients. In total 67% had ≥ 1 unaddressed treatable trait. 43% had at least one increased T2-marker (FeNO ≥ 20 ppb or B-eos ≥ 0.3x109 /L). <bold>Conclusion:</bold> Using a systematic assessment protocol for the evaluation of patients with severe COPD identified unaddressed treatable traits in two-thirds of the patients. T2 inflammation was common. These findings highlight the need for a systematic approach in severe COPD.