P301 Eosinophilic inflammation in asthma and COPD: a UK biobank study

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Introduction and Objectives Eosinophilic inflammation is recognised to play an important role in asthma. This is reflected in the recent British Thoracic Society (BTS) guidelines which focus on assessing fortype 2 inflammation, particularly elevated eosinophil count,when making a diagnosis of asthma. We investigated the pattern of eosinophilic inflammation in patients with asthma and chronic obstructive pulmonary disease (COPD) in the UK biobank. Methods UK Biobank participants were screened for a coded diagnosis of asthma, COPD or asthma/COPD overlap at baseline or in linked clinical records. We recorded the highest ever eosinophil count taken since the year preceding diagnosis. Participants were separated into three groups: highest recorded eosinophil count ≥ 0.3 x 109/L, >0.15 and <0.3 x 109/L, and ≤0.15 x 109/L. This was compared to control data from participants without diagnosed asthma/COPD. Demographics and summary results are described in table 1. Results In total there were 33191 patients with asthma, 8130 patients with COPD, and 6915 with both diagnoses. When taking the highest recorded value, 9761 (29.4%) patients with asthma, 2620 (32.2%) patients with COPD, and 2404 (34.8%) patients with both diagnoses had an eosinophil count ≥ 0.3 x 109/L. This was compared to 411382 controls, of whom 93781 (22.8%) had an eosinophil count ≥ 0.3 x 109/L. Conclusions Rates of eosinophilic inflammation were similar in patients with asthma, COPD and asthma plus COPD. This suggests that there may be shared treatable traits across disease boundaries. The high rate of eosinophilic inflammation in COPD is particularly relevant given recent interest in monoclonal antibody therapy for COPD patients and suggests that a significant proportion of patients may be eligible for such treatment. It is evident from this data that elevated eosinophil count is a poor discriminator between asthma and COPD. Clinicians should be mindful of this, especially in the context of recent BTS asthma guidelines which may prompt a diagnosis of asthma in the setting of elevated eosinophil count. 70.6% of asthma patients have never had high eosinophils, emphasising the role of eosinophil count as a rule-in rather than rule-out test for asthma, with a low diagnostic sensitivity.

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