BackgroundThere is growing evidence that upper airway symptoms coexist with lower airway symptoms in Chronic Obstructive Pulmonary Disease (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.MethodsWe examined a cohort of COPD patients with pulmonary function tests, induced sputum, blood eosinophils, atopy tests, 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.FindingsIn total, 180 patients (female 55%, age 67 (±8) years, FEV1% 52.4 (±16.6), GOLD stage: A:18%, B:54%, C:3%, D:25%) were included in the study. Seventy-four patients (41%) reported high upper airway symptoms (high 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.ConclusionCOPD patients with upper airway disease showed increased evidence of eosinophilic disease and increased lower airway symptom burden.
Upper airway symptoms associate with the eosinophilic phenotype of COPD
