Irreversible Airflow Limitation in Elderly Adults with a History of Severe Childhood Asthma – COPD-A, COPD-C or?

Abstract Background According to the GOLD 2023 strategy paper, classification of chronic obstructive pulmonary disease (COPD) may include distinct COPD types. We applied the GOLD classification of COPD-A and COPD-C in a follow-up of a cohort of adults with a history of severe childhood asthma. Methods We performed a 60-year clinical follow-up of adults with a history of severe childhood asthma and a previous stay at an asthma care facility. COPD-A and COPD-C were defined as post-bronchodilator FEV1/FVC < 0.7 and never-smoker or ever smoker, respectively. Factors possibly associated with irreversible airflow limitation, including demographics, dyspnea severity, blood eosinophil count (BEC), and concomitant diseases were examined. Results The final cohort comprised 232 individuals, of whom 30 and 23, respectively, were classified as COPD-A and COPD-C. Compared to those with no airflow limitation, both individuals with COPD-A and COPD-C more often had had at least one exacerbation in the past 12 months (Risk ratio [RR] 1.83 and RR 2.65, respectively). The COPD-C group had significantly higher MRC dyspnea score (p < 0.01) and higher BEC (p < 0.01) compared to those with no airflow limitation. Compared to COPD-C, COPD-A had higher FeNO (mean 29 [SD 28]). Finally, when comparing participants with COPD-A to COPD-C and participants without airflow limitation, the proportion having osteoporosis and depression were more than doubled. Conclusions In late adulthood, one in four with a history of severe asthma in childhood had developed COPD. COPD-A had higher FeNO, while COPD-C was associated with more dyspnea, higher BEC, and also the highest exacerbation risk.