Drivers of Eosinophilic COPD Exacerbations

Study Overview
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Brief Summary
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Main objective: investigate gene expression differences in nasal epithelium and sputum between eosinophilic COPD exacerbations and other subtypes.

Detailed Description
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Main objective: investigate gene expression differences in nasal epithelium and sputum between eosinophilic COPD exacerbations and other subtypes to better understand why some patients are more at risk for eosinophilic COPD exacerbations. Secondary objectives: Investigate differences in microbiome composition and immunophenotyping profiles in peripheral blood per subtype. Assess for clinical differences between all COPD exacerbation subtypes. Assess if and how baseline meta-transcriptomics either in nasal epithelium or sputum and blood immunophenotyping can be utilized to predict COPD exacerbation subtype. Determine if the microbiome in sputum and nasal epithelial material are comparable. Determine if different subtypes of COPD exacerbations respond differently to standard treatment with oral prednisolone (40 mg daily) with or without antibiotics. To evaluate if metabolic responses during recovery are different in patients with increased systemic inflammation compared to patients without systemic inflammation at exacerbation

Official Title
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Drivers of Eosinophilic COPD Exacerbations

Conditions
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COPD Exacerbation, Eosinophilia

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: COPD patient admitted to the hospital for an acute exacerbation of COPD Physician diagnosed COPD according to the GOLD 2020 guidelines, including symptoms consistent with COPD, post-bronchodilator FEV1 < 80% predicted and FEV1/FVC < 70%. Age > 40 years. Smoker or ex-smoker, ≥ 10 pack years of smoking. Exclusion Criteria: Current asthma, or prior physician diagnosis of asthma without a symptom- free interval of at least 10 years before the age of 40. Chronic use of prednisolone. Use of systemic corticosteroids ≥4 days prior to hospital admission. Necessity (upon hospitalization) for non-invasive ventilation or ICU admission. Pneumonia at presentation documented by chest roentgenography. Any other clinically relevant lung disease deemed to interfere with the concept of the study design. Allergy to systemic corticosteroids or to antibiotics. Females of childbearing potential without an efficient contraception unless they meet the following definition of post-menopausal: 12 months of natural (spontaneous) amenorrhea or 6 months of spontaneous amenorrhea with serum FSH >40 mIU/mL or the use of one or more of the following acceptable methods of contraception: Surgical sterilization (e.g. bilateral tubal ligation, hysterectomy). Hormonal contraception (implantable, patch, oral, injectable). Barrier methods of contraception: condom or occlusive cap (diaphragm or cervical/vault caps) with spermicidal foam/gel/cream/suppository. Continuous abstinence Pregnancy or lactation. Known immunodeficiency. Life expectancy less than 60 days

Ages Eligible for Study
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Minimum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Eosinophilic exacerbation<br>COPD exacerbation associated with eosinophilia. | |
| Viral exacerbation<br>COPD exacerbation associated with viral infection. | |
| Bacterial exacerbation<br>COPD exacerbation associated bacterial infection. | |
| Pauci-inflammatory exacerbation<br>Pauci-inflammatory COPD exacerbation | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in gene expression profiles in sputum by RNA sequencing | Change in gene expression profiles in sputum between the four groups using RNA sequencing. The differences between the expression levels of transcripts (counts) will be analyzed. | At admission and after 6-8 weeks after discharge. | 
| Change in gene expression profiles in nasal epithelium by using RNA sequencing | Change in gene expression profilesin nasal epithelium between the four groups using RNA sequencing. The differences between the expression levels of transcripts (counts) will be analyzed. | At admission and after 6-8 weeks after discharge. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Microbiome composition in sputum by using RNA sequencing. | Differences in microbiome composition in sputum between the four groups by using RNA sequencing. | At admission, at day 5 of admission and 6-8 weeks after discharge. | 
| Phenotype blood cell population by flow cytometry. | Differences in blood cell population between the four groups as measured by flow cytometry. | At admission, at day 5 of admission and 6-8 weeks after discharge. | 
| Phenotypic analysis of the T cell compartment by staining of whole blood or isolated peripheral blood mononuclear cells using antibodies | Differences in the T cell compartment between the four groups by staining of whole blood or isolated peripheral blood mononuclear cells using antibodies. | At admission, at day 5 of admission and 6-8 weeks after discharge. | 
| Comparison of microbiome composition in sputum and nasal epithelial material by RNA sequencing. | Measure microbiome composition in sputum and nasal epithelium by RNA sequencing. Compare them by the bacterial taxa which are significantly different between groups | At admission and 6-8 weeks after discharge. | 
| Clinical differences between groups by the COPD Assessment Test (CAT). | Differences in number of participants per group with a high impact of COPD related symptoms as assessed by the CAT. | Every day of hospital admission. | 
| Clinical differences between groups by peak flow measurements. | Differences in number of participants per group with a low peak expiratory flow rate as measured by a handheld peak flow meter. | Every day of hospital admission. |