KRONİK OBSTRÜKTİF AKCİĞER HASTALIĞI FENOTİPLENDİRMESİ: ATOPİNİN ÖNEMİ

Abstract

Goktas, G., Chronic Obstructive Pulmonary Disease Phenotyping: The Importance of Atopy Hacettepe University, Faculty of Medicine, Thesis for Speciality in Pulmonology, Ankara, 2025. Chronic obstructive pulmonary disease (COPD) stands as a major respiratory condition marked by diverse clinical features, calling for tailored treatment strategies. The goal of this research was to assess how common type 2 inflammation is among COPD patients and to contrast those with type 2 inflammation (type 2 COPD) against those without it (non-type 2 COPD) based on demographics, clinical signs, treatment regimens, exacerbation rates, and overall disease severity. This investigation involved 215 COPD patients monitored at the Chest Diseases Outpatient Clinic of Hacettepe University Faculty of Medicine. Participants were categorized into the type 2 inflammation group if their blood eosinophil count reached ≥300 cells/µL, if atopy was detected, or if those with counts ≥150 cells/µL showed use of high-dose inhaled corticosteroids alongside symptoms of seasonal allergic rhinitis. Evaluations included pulmonary function tests (PFTs), symptom assessments (mMRC, CAT, SGRQ), treatment approaches, histories of exacerbations, associated conditions, imaging results, and lab values. Data analysis relied on SPSS software, deeming differences significant at p<0.05. Results indicated type 2 inflammation in 56% of cases. Among the type 2 COPD cohort, inhaled corticosteroid (ICS) use—especially at higher doses—and combinations with long-acting beta-agonists (LABA) were notably more frequent (p<0.05). Exacerbation occurrences, along with antibiotic and systemic steroid prescriptions, appeared elevated in type 2 COPD, though these trends approached but did not fully reach statistical significance. Within the GOLD E category, bronchiectasis and audible rales were more prevalent in patients exhibiting type 2 inflammation (p<0.05). No meaningful variances emerged in symptom scores or spirometry measures across groups. Atopy prevalence stood at 10%. Overall, type 2 inflammation emerges as a frequent subtype in COPD, linked to better responses to ICS and heightened exacerbation risks. While atopy aids in classifying COPD phenotypes, it plays a less central role than eosinophilia. These insights highlight the value of biomarker-guided, individualized therapies for managing COPD. Moving forward, research should emphasize long-term monitoring and collaborative efforts across multiple sites to strengthen these observations.