IntroductionA subset of COPD patients develops advanced disease with severe airflow obstruction, hyperinflation and extensive emphysema. We propose that the pathogenesis in these patients differs from mild–moderate COPD and is reflected by bronchial gene expression. The aim of the present study was to identify a unique bronchial epithelial gene signature for severe COPD patients.MethodsWe obtained RNA sequencing data from bronchial brushes from 123 ex-smokers with severe COPD, 23 with mild–moderate COPD and 23 non-COPD controls. We identified genes specific to severe COPD by comparing severe COPD to non-COPD controls, followed by removing genes that were also differentially expressed between mild–moderate COPD and non-COPD controls. Next, we performed a pathway analysis on these genes and evaluated whether this signature is retained in matched nasal brushings.ResultsWe identified 219 genes uniquely differentially expressed in severe COPD. Interaction network analysis identifiedVEGFAandFN1as the key genes with the most interactions. Genes were involved in extracellular matrix regulation, collagen binding and the immune response. Of interest were 10 genes (VEGFA,DCN,SPARC,COL6A2,MGP,CYR61,ANXA6,LGALS1,C1QAandC1QB) directly connected to fibronectin 1 (FN1). Most of these genes were lower expressed in severe COPD and showed the same effect in nasal brushings.ConclusionsWe found a unique severe COPD bronchial gene signature with key roles forVEGFAandFN1, which was retained in the upper airways. This supports the hypothesis that severe COPD, at least partly, comprises a different pathology and supports the potential for biomarker development based on nasal brushes in COPD.