Prevalence of Chronic Obstructive Pulmonary Disease and Asthma in Polycythemia Vera and Essential Thrombocythemia and Its Prognostic Implications

<b>Background:</b> The prevalence and the prognostic impact of chronic obstructive pulmonary disease (COPD) and asthma in patients with myeloproliferative neoplasms (MPNs) are unknown. <b>Methods:</b> This retrospective multicenter cohort analyzed the prevalence and prognostic implications of COPD and asthma in 246 patients with essential thrombocythemia (ET) and polycythemia vera (PV). <b>Results:</b> A total of 6.5% and 1.6% patients had COPD or asthma, respectively, without statistically significant differences with respect to disease phenotype. The presence of COPD/asthma was more frequently associated with active/prior smoking (<i>p</i> = 0.021) and constitutional symptoms (<i>p</i> = 0.001). After the median follow-up of 47.5 months, the presence of COPD/asthma was univariately associated with an inferior time to thrombosis (TTT; median 135 vs. 190 months, 95% confidence interval (CI) 1.8-29.5, hazard ratio-HR 7.75, <i>p</i> = 0.005), mainly driven by venous (HR 37.3, 95% CI 3.2-43.6, <i>p</i> = 0.003) and not arterial events (HR 1.77, 95% CI 0.40-7.78, <i>p</i> = 0.445, <i>p</i> = 0.445). Statistically significant interactions existed between COPD/asthma, female sex (HR 3.94, 95% CI 1.01-11.02), ET phenotype (HR 7.1, 95% CI 15.3-16.7), <i>JAK2</i> positive status (HR 4.17, 95% CI 1.04-6.9), hydroxyurea use (HR 4.67, 95% CI 1.10-7.43), and the presence of other cardiovascular risk factors (HR 8.1, 95% CI 1.55-10.72) with overall thrombotic risk (interaction <i>p</i> < 0.050 for all analyses). Finally, the negative effect of COPD/asthma on TTT persisted in the multivariate analysis (HR 6.54, <i>p</i> = 0.010) independently of older (>60 years) age (<i>p</i> = 0.030) when being adjusted for other clinically meaningful variables. There was no effect of COPD/asthma on overall survival. <b>Conclusions</b>: These results provide an important signal regarding the potentially inferior outcomes in ET/PV patients presenting with these common respiratory disorders and may help to further personalize MPN management.