TY - JOUR T1 - Upper airway symptoms associate with the eosinophilic phenotype of COPD JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00184-2021 VL - 7 IS - 3 SP - 00184-2021 AU - Nicolai Obling AU - Vibeke Backer AU - John R. Hurst AU - Uffe Bodtger Y1 - 2021/07/01 UR - http://openres.ersjournals.com/content/7/3/00184-2021.abstract N2 - Background There is growing evidence that upper airway symptoms coexist with lower airway symptoms in COPD. Still, the prevalence and impact of upper airway disease on the nature and course of COPD remain unclear. We aimed to describe this in a cross-sectional study.Methods We examined a cohort of COPD patients with pulmonary function tests, induced sputum, blood eosinophils, atopy tests and computed tomography (CT) of the paranasal sinuses. Lower airway symptoms were assessed using the COPD Assessment Test (CAT), and upper airway symptoms were assessed using the nasal subdomain of the 22-item Sino Nasal Outcome Test (SNOT22nasal). We recruited patients from five sites in Denmark and Sweden. We excluded patients with a history of asthma.Findings In total, 180 patients (female 55%, age 67±8 years, forced expiratory volume in 1 s (FEV1 %) 52.4±16.6, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage: A: 18%, B: 54%, C: 3%, D: 25%) were included in the study. Seventy-four patients (41%) reported high upper airway symptoms (UAS, defined as SNOT22nasal≥6) with a median score of 10 (IQR 8–13). Patients with high UAS reported higher CAT scores (17.4±7.5 versus 14.9±6.6, p<0.05) and displayed higher fractions of eosinophils in blood (median 3.0% (IQR 1.6–4.2%) versus 2.3% (IQR 1.4–3.1%), p<0.05) and in induced sputum (median 1.8% (IQR 0.3–7.1%) versus median 0.5% (IQR 0–1.7%), p<0.05). No differences in atopy, CT findings or exacerbation rates were observed.Conclusion COPD patients with upper airway disease showed increased evidence of eosinophilic disease and increased lower airway symptom burden.Upper airway symptoms are common in COPD, and are associated with elevated CAT scores and more pronounced systemic and airway eosinophilia https://bit.ly/3iIKBUS ER -