Abstract Background Chronic Obstructive Pulmonary Disease (COPD) places a significant burden on the Irish healthcare system accounting for 15,000 hospitalisations annually with over 380,000 patients living with the condition (1). The NOTUS (2) and BOREAS (3) trials demonstrated a reduction in COPD exacerbations in patients with eosinophils ≥300/µL with the anti-IL-4/13 dupilumab compared to placebo. Dupilumab has since been included in GOLD guidelines (4); however it has not yet been approved for this indication in Ireland. Mepolizumab has also been investigated for a similar patient cohort. The aim of this study was to investigate the prevalence of type 2 inflammation among patients with COPD presenting to the emergency department (ED) in a tertiary referral centre in Ireland and identify patients who could benefit from targeted therapy to reduce exacerbation burden. Methods Single center observational study looking at patients who attended the ED with COPD included in their presenting complaint between July 2024 -July 2025. Data collected included patient demographics, clinical presentation, age, sex, blood eosinophils, comorbidities, smoking status, treatment, and pulmonary function testing. Results 1103 patients attended the ED between July 2024 and July 2025 with COPD mentioned in their presenting complaint. This comprised 243 patients presenting with COPD exacerbations, requiring 380 hospital admissions. These patients had an average of 1.57 hospital admissions during this period. Average eosinophils were 640/µL with 83 % (n = 201) having eosinophils ≥300/µL. 14% (n = 35) also had a diagnosis of asthma. 22% (n = 53) were actively smoking or vaping at the time of admission. 30% (n = 72) had eosinophils ≥ 300/µL recorded despite treatment with oral corticosteroids during admission. 73% (n = 178) were prescribed maintenance COPD therapy with long acting muscarinic antagonist/long acting beta agonist/inhaled corticosteroids (LAMA/LABA/ICS) prior to admission. Mean FEV1 was 59% predicted. 7% (n = 17) were prescribed maintenance steroid treatment with prednisolone at a dose of 5mg the most commonly used agent. Conclusion COPD exacerbations are burdensome both on the healthcare system and on patients. Type 2 inflammation, as indicated by blood eosinophil counts ≥300/µL, is a demonstrated treatable trait in COPD. 83% of our studied patients met criteria for biologic therapy despite treatment with inhaled corticosteroids and 30% met criteria despite treatment with oral corticosteroids. Targeted therapy for type 2 inflammation with interleukin 4/13 blocker dupilumab should be considered for approval in Ireland to reduce exacerbation frequency among these patients. This abstract is funded by: None
Mccarthy et al. (Fri,) studied this question.