Clinical profile of chronic obstructive pulmonary disease patients with and without type 2 inflammation: A comparative study

ABSTRACT BACKGROUND: The association between chronic obstructive pulmonary disease (COPD) with type 2 inflammation and comorbidities and functional outcomes remains incompletely defined. We aimed to compare clinical characteristics, comorbidities, and exacerbation risk between COPD patients with and without type 2 inflammation. METHODS: This was a retrospective observational study. Patients with spirometry-confirmed COPD between January 2020 and July 2025 were included. Patients were stratified by serum eosinophil count into type 2 inflammation COPD (≥300 cells/μL) and nontype 2 inflammation COPD (<300 cells/μL). Demographics, comorbidities, pulmonary function, and exacerbation history were assessed. Logistic regression identified independent predictors of exacerbation. RESULTS: The total number of patients were 270 (mean age: 70 years; 91.5% of males). Among them, 54.8% had type 2 inflammation COPD. Those with type 2 inflammation had more comorbidities (mean 3 vs. 2; P = 0.001), higher prevalence of ischemic heart disease (31.1%; P = 0.042), and increased exacerbation frequency (mean 2 vs. 1 per year; P = 0.006). Predictors of exacerbation included older age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00–1.04), high eosinophilic count (OR 1.002, 95% CI 1.001–1.003), number of exacerbations in the past 12 months (OR 1.04, 95% CI 1.01–1.06), elevated right ventricular pressure (OR 1.06, 95% CI 1.03–1.10), lower postbronchodilator FEV1 (OR 1.03, 95% CI 1.01–1.05) and multiple comorbidities (OR 1.18, 95% CI 1.05–1.34). CONCLUSION: COPD with type 2 inflammation is associated with a higher prevalence of ischemic heart disease and a higher prevalence and higher risk of exacerbation compared with nontype 2 inflammation. Serum eosinophil count is a valuable biomarker for phenotyping and risk stratification.