Upper Respiratory Symptoms in Patients with Chronic Obstructive Pulmonary Disease

<b>Background:</b> There is growing evidence that nasal symptoms coexist with lower respiratory symptoms in Chronic Obstructive Pulmonary Disease (COPD), but prevalence and impact on nature and course of COPD remains unclear. We aimed to describe this in a real-life, non-randomized, observational study. <b>Methods:</b> In this study, we examined a cohort of patients with confirmed COPD (Post-BD FEV1/FVC &lt;0.70) with pulmonary function tests, induced sputum, blood eosinophils and questionnaires on respiratory and nasal symptoms using the COPD assessment test (CAT score) and the nasal subdomain of the 22-item Sino Nasal Outcome Test (SNOT22nasal =questions 1-6,8). Patients were recruited from the BREATHE study at five sites in Denmark and Sweden. Presence of nasal symptoms was defined as a SNOT22-nasal of ≥6 points. Patients with a history of asthma were excluded. <b>Findings:</b> In total, 186 patients (female 54%, mean age 67 (±8.4) years, FEV1% predicted 52.9% (±16.7), GOLD stage: A: 19%, B: 55%, C: 2%, D: 24%) were included in the study. Overall, 78 patients (42%) reported nasal symptoms with a median score of 10 (IQR 8-13). Patients with nasal symptoms reported higher CAT scores (17.6 (±7.5) vs. 14.9 ±6.6; p&gt; 0.01). Patients with nasal symptoms also displayed significantly higher levels of eosinophils in induced sputum (median 2.9% (IQR 1.6-4.8) vs. 2.4 (IQR 1.4-3.1)) and blood (median 1.91 (IQR 0.3-7.1) vs. median 0.56 (IQR 0-1.9)). No significant differences observed in the prevalence of atopy, in pulmonary function tests or in the rate of exacerbations. <b>Conclusion:</b> Nasal symptoms were prevalent among COPD patients and were associated with eosinophilia and increased COPD symptom burden.