{
  "abstract": "Background Type 2 (T2) inflammatory biomarkers are known to be elevated among patients with eosinophilic COPD receiving inhaled corticosteroids (ICS). However, a significant research gap exists regarding the impact of objective inhaler adherence on these biomarkers.Aim To explore how inhaler adherence stability influences type 2 biomarkers.Method COPD patients on triple inhaled therapy were electronically monitored for inhaler adherence over 6 months using FindAir digital inhalers. Adherence was classified as persistently adherent (adherence rate (AR)≥75% in all visits), intermittently or persistently non-adherent (AR<75%). Blood and sputum eosinophils, immune cell profiles, and fractional exhaled nitric oxide (FeNO) were monitored.Result Of 104 patients (age 67±9 yrs, FEV 1=1.1±0.5L), median [IQR] AR per participant was 70% [44 - 86] over 6 months, significantly decreasing over time (p<0.001 at month 4 onwards). Prescription refills and self-reports significantly overestimated true adherence (p<0.001). Only 30% were persistently adherent to maintenance ICS at all time (figure 1). Participants with eosinophilic COPD tended to be more persistently adherent than their counterparts, 45% vs 25%, p=0.05. Persistently adherent patients had higher baseline sputum T2-polarised T-cells (p=0.03) and lower FeNO levels (13[10–21] vs 17 [12–33] ppb, p=0.05) with greater ICS exposure, (402 [374–445] vs 278 [150–331] mcg BDP equivalence, p<0.001) than the rest. No significant change over time was observed in blood eosinophils, immune cells, FeNO or lung function across adherence groups.Abstract P159 Figure 1Alluvial Plot Illustrating Longitudinal Inhaler Adherence. Adherence rate among participants were stratified as (Persistently adherent: adherence rate AR≥75% at all visits, intermittent: AR<75% ≥1 visits, and persistently non-adherent: AR<75% at all visits) alongside transitions in blood eosinophil count over time, at study visits V1, V2, V3, V5, and V7. At baseline, participants were classified as T2High (highest BEC ≥ 0.3 x 109/L in the prior year) or non-T2High. AR at each visit was categorised as low (AR<50%), moderate (AR 50–74%), or high (AR≥75%). Changes in blood eosinophils across visits were analysed using mixed-effect modelsConclusion Findings suggest a disconnect between ICS adherence and T2 inflammatory biomarkers in COPD, a pattern that contrasts with what is typically observed in asthma.",
  "authors": [
    {
      "affiliations": [
        "Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "H Aung"
    },
    {
      "affiliations": [
        "Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "K Ntotsis"
    },
    {
      "affiliations": [
        "Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "P Novotny"
    },
    {
      "affiliations": [
        "Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "P Ashley"
    },
    {
      "affiliations": [
        "Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "H Evans"
    },
    {
      "affiliations": [
        "Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "K Balasundaram"
    },
    {
      "affiliations": [
        "Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "W Monteiro"
    },
    {
      "affiliations": [
        "Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "SE Parker"
    },
    {
      "affiliations": [
        "Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "SA Edwards"
    },
    {
      "affiliations": [
        "Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "M Bourne"
    },
    {
      "affiliations": [
        "Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "M Iqbal"
    },
    {
      "affiliations": [
        "Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "M Steiner"
    },
    {
      "affiliations": [
        "Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "RA Evans"
    },
    {
      "affiliations": [
        "Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "CE Brightling"
    },
    {
      "affiliations": [
        "Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "A Murphy"
    },
    {
      "affiliations": [
        "Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "A Wright"
    },
    {
      "affiliations": [
        "Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "NJ Greening"
    }
  ],
  "title": "P159 Stability and relationship between digitally monitored inhaled corticosteroids adherence and type 2 biomarkers in COPD",
  "uid": "64a035a1-0ad3-5024-a9d0-b1fbbf147106"
}