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UNDERSTANDING
TYPE 2 INFLAMMATION right arrow
Think COPD Inflammation Logo
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THE ROLE OF TYPE 2 INFLAMMATION

Noteworthy icon bulb

Up to

40%

of patients with COPD may
have type 2 inflammation18-22,a

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TYPE 2 INFLAMMATION MAY INCREASE THE RISK OF EXACERBATIONS AND LUNG FUNCTION IMPAIRMENT IN COPD23,24

COPD is characterized by mucus production, airway obstruction, and coughing13

lung-function

Inflammation manifests systemically and locally

Systemic inflammation

Elevated blood eosinophils
are associated with

1.76x

greater risk
for a severe COPD
exacerbation26,b

icon-lungs-blue

More impaired
lung function27,c

Localized inflammation25

Controld
fritzsching-histo-control
COPDd
fritzsching-histo-copd
Mucuse
  • Chronic inflammation causes structural changes, including narrowing of the airways and decreased lung elasticity13
  • Studies have identified a relationship between inflammation and mucus hypersecretion in respiratory conditions such as COPD25

Identifying type 2
inflammation may help you discover at-risk patients13

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LOOK FOR ELEVATED BLOOD EOSINOPHILS (≥300 CELLS/µL)—A BIOMARKER OF TYPE 2 INFLAMMATION IN COPD13
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Elevated blood eosinophils in COPD serve as a marker of type 2 inflammation13

  • The 2024 GOLD Report recognizes elevated blood EOS as a clinically useful biomarker in identifying COPD with type 2 inflammation

Type 2 inflammation
in COPD can involve multiple
pathways, cytokines,
and inflammatory cells28-33

moa chart

IL-4, IL-13, and IL-5 are
type 2 cytokines involved
in COPD

IL-4

IL-13

IL-4 and IL-13 drive inflammatory cell activity34-43

IL-4 and IL-13 promote the activation and trafficking of type 2 inflammatory cells, including eosinophils, to the lungs, which may contribute to airway remodeling and parenchymal destruction in COPD.

IL-13

The critical role of IL-13 in airflow limitation11,36,43-47

IL-13 plays a role in emphysema, fibrosis, and goblet cell hyperplasia and increases expression of MUC5AC, a major constituent of airway mucus.

  • Levels of IL-13 are significantly increased in lungs from patients with severe COPD compared with healthy donor tissue
moa chart
icon target

Understanding type 2 inflammation in COPD may help shed light on why some patients continue to experience exacerbations.13

RESOURCES
aBased on findings from 5 studies in COPD patients without asthma. Eosinophil levels used to define type 2 inflammation ranged from ≥300 cells/μL to ≥340 cells/μL (blood), ≥2% in induced sputum or 3% in peripheral blood. Percentages of patients with type 2 inflammation ranged from 12.3% to ~40%.23,24
bA severe exacerbation was defined as a hospitalization due to COPD. Exacerbations had to be a minimum of 4 weeks apart to be considered separate exacerbations.27
cIn a cohort of patients with EOS >200 cells/μL.26
dReproduced with permission of the American Thoracic Society. Fritzsching B et al. Am J Respir Crit Care Med. 2015;191(8):902-913.25
eAlcian blue PAS staining of mucus in airway epithelial cells.25
fResults from an observational study of 1553 patients with GOLD spirometry grade 2-4 COPD (postbronchodilator FEV1/FVC ratio <0.7, with FEV1 >80% predicted).23
gResults from a 1-year observational study of 479 patients with COPD, 173 of whom had blood eosinophil levels ≥200 cells/μL and/or ≥2% of the total white blood cell count.24
COPD, chronic obstructive pulmonary disease; EOS, eosinophils; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; IFN-γ, interferon-gamma; ILC2, innate lymphoid type-2 cells; MUC5AC, mucin 5AC; PAS, periodic acid-Schiff; TNF-α, tumor necrosis factor alpha; TSLP, thymic stromal lymphopoietin.
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