scholarly journals Blood eosinophils as a marker of response to inhaled corticosteroids in COPD

2016 ◽  
Vol 47 (5) ◽  
pp. 1374-1382 ◽  
Author(s):  
Neil C. Barnes ◽  
Raj Sharma ◽  
Sally Lettis ◽  
Peter M.A. Calverley
Keyword(s):  
Fluticasone Propionate ◽  
Eosinophil Count ◽  
Inhaled Corticosteroids ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Severe Exacerbation ◽  
Exacerbation Rate ◽  
Blood Eosinophil Count ◽  
Rate Of Decline

Identification of a biomarker that predicts response to inhaled corticosteroids (ICS) would help evaluate the risk/benefit profile of ICS in chronic obstructive pulmonary disease (COPD) and guide treatment.The ISOLDE study randomised 751 patients (mean post-bronchodilator forced expiratory volume in 1 s (FEV1) 1.4 L: 50% predicted normal) to fluticasone propionate 500 μg twice daily or placebo for 3 years, finding no difference in FEV1 rate of decline between treatments (p=0.16) and a significant reduction in median exacerbation rate with fluticasone propionate versus placebo (p=0.026). We re-analysed ISOLDE results by baseline blood eosinophil count to investigate whether eosinophil level predicts ICS benefit.Patients with eosinophils <2% (n=456) had a similar rate of post-bronchodilator FEV1 decline with fluticasone propionate as placebo (–2.9 mL·year−1; p=0.688). With eosinophils ≥2% (n=214), the rate of decline decreased by 33.9 mL·year−1 with fluticasone propionate versus placebo (p=0.003). Exacerbation rate reduction on ICS for fluticasone propionate versus placebo was higher in the eosinophil <2% group compared with the ≥2% group; time-to-first moderate/severe exacerbation was not different between treatments in either group.A baseline blood eosinophil count of ≥2% identifies a group of COPD patients with slower rates of decline in FEV1 when treated with ICS: prospective testing of this hypothesis is now warranted.

scholarly journals Blood eosinophil count and risk of pneumonia hospitalisations in individuals with COPD

2018 ◽  
Vol 51 (5) ◽  
pp. 1800120 ◽  
Author(s):  
Signe Vedel-Krogh ◽  
Børge G. Nordestgaard ◽  
Peter Lange ◽  
Jørgen Vestbo ◽  
Sune F. Nielsen
Keyword(s):  
High Risk ◽  
General Population ◽  
Eosinophil Count ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Exacerbation Rate ◽  
General Population Study ◽  
Blood Eosinophil Count ◽  
Eosinophil Counts

Blood eosinophil count in chronic obstructive pulmonary disease (COPD) is associated with higher exacerbation rate and favourable response to corticosteroids; however, frequent exacerbations and use of inhaled corticosteroids could elevate pneumonia risk. We tested the hypothesis that high blood eosinophil counts are associated with high risk of pneumonia in individuals with severe COPD from the general population.We included 7180 individuals with COPD from the Copenhagen General Population Study, including 643 with forced expiratory volume in 1 s (FEV1) <50% predicted between 2003 and 2011. All primary discharge diagnoses of pneumonia during follow-up were recorded.Among individuals with COPD and FEV1<50% pred, the multivariable adjusted incidence rate ratio was 2.17 (95% CI 1.31–3.58) for pneumonia comparing individuals with blood eosinophil counts ≥0.34×109 cells·L−1versus<0.34×109 cells·L−1. In individuals with clinical COPD, defined by recent exacerbation, ≥10 pack-years of smoking and FEV1<70% pred, the corresponding risk was 4.52 (2.11–9.72). Risk of pneumonia did not differ by blood eosinophil count in individuals with COPD and FEV1≥50% pred.In individuals with COPD and FEV1<50% pred, blood eosinophil count ≥0.34×109 cells·L−1was associated with high risk of hospitalisation due to pneumonia.

Absolute Blood Eosinophil Counts to Guide Inhaled Corticosteroids Therapy Among Patients with COPD: Systematic Review and Meta-analysis

2019 ◽  
Vol 20 (16) ◽  
pp. 1670-1679 ◽  
Author(s):  
Olorunfemi A. Oshagbemi ◽  
Jephthah O. Odiba ◽  
Abraham Daniel ◽  
Ismaeel Yunusa
Keyword(s):  
Systematic Review ◽  
Eosinophil Count ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Blood Eosinophil Count ◽  
Copd Patients ◽  
Phenotypic Group ◽  
Increased Risk ◽  
Eosinophil Counts

Introduction: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2019 recommends the use of absolute blood eosinophil count as a guide for the escalation and de-escalation of inhaled corticosteroids (ICS) in the pharmacological management of patients with chronic obstructive pulmonary disease (COPD). We evaluated the risk of moderate or severe exacerbations among patients escalating and de-escalating ICS therapy by absolute blood eosinophil thresholds in this systematic review. Methods: Through a comprehensive literature search of Pubmed/MEDLINE, EMBASE, and clinical trial sites up to April 2019, we identified relevant studies. We used generic inverse variance method with fixed-effects estimates to compare the risk of moderate or severe exacerbations among COPD patients with elevated blood eosinophil counts exposed to inhaled corticosteroids (ICS) versus non-ICS treatments groups expressed as risk ratios. Results: Ten studies (8 randomised control trials and 2 observational studies) were included, with a total of 85,059 COPD patients. In our pooled analysis, we found an overall reduction in risk of moderate or severe exacerbations in patients with absolute blood eosinophil thresholds ranging from ≥ 100 to ≥ 340 cells/µL among patients escalating ICS (RR, 0.77, 95% CI, 0.73-0.81). For studies evaluating the effects of de-escalation of ICS on moderate to severe exacerbations using blood eosinophil thresholds of ≥ 300 to ≥ 340 cells/µL had an increased risk of moderate or severe exacerbations following the de-escalation of ICS (RR, 1.66, 95% CI, 1.31-2.10). Conclusion: This study confirms the validity of the recommended absolute blood eosinophil count thresholds for the escalation and de-escalation of ICS among COPD patients. However, this recommendation is for COPD patients with prior exacerbations rather than among newly diagnosed COPD patients as observed in this study. COPD patients with current or past history of asthma represent a unique phenotypic group which should be further evaluated.

Prevalence of Asthma-COPD Overlap in COPD and Severe Asthma Cohorts

2021 ◽  
Author(s):  
Hyonsoo Joo ◽  
So-Young Park ◽  
So Young Park ◽  
Seo Young Park ◽  
Sang-Heon Kim ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Eosinophil Count ◽  
Clinical Manifestations ◽  
Forced Expiratory Volume ◽  
Smoking History ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Obstructive Pulmonary Disease ◽  
Blood Eosinophil Count ◽  
Bronchodilator Response

Abstract Background: Asthma and chronic obstructive pulmonary disease (COPD) are airway diseases with similar clinical manifestations, despite differences in pathophysiology. Asthma-COPD overlap (ACO) is a condition characterized by overlapping clinical features of both diseases. There have been few reports regarding the prevalence of ACO in COPD and severe asthma cohorts. ACO is heterogeneous; patients can be classified on the basis of phenotype differences. This study was performed to analyze the prevalence of ACO in COPD and severe asthma cohorts. In addition, this study compared baseline characteristics among ACO patients according to phenotype.Methods: Patients with COPD were prospectively enrolled into the Korean COPD subgroup study (KOCOSS) cohort. Patients with severe asthma were prospectively enrolled into the Korean Severe Asthma Registry (KoSAR). ACO was defined in accordance with the updated Spanish criteria. In the COPD cohort, ACO was defined as bronchodilator response (BDR) ≥ 15% and ≥ 400 mL from baseline or blood eosinophil count ≥ 300 cells/μL. In the severe asthma cohort, ACO was defined as age ≥ 35 years, smoking ≥ 10 pack-years, and post-bronchodilator forced expiratory volume in 1 s/forced vital capacity < 0.7. Patients with ACO were divided into four groups according to smoking history (threshold: 20 pack-years) and blood eosinophil count (threshold: 300 cells/μL).Results: The prevalence of ACO significantly differed between the COPD and severe asthma cohorts (19.8% [365/1839] vs. 12.5% [104/832], respectively, P < 0.001). The numbers of patients in each group were as follows: Group A (smoking 10–20 pack-years and blood eosinophil count ≥ 300 cells/μL), 42 (9.1%); Group B (smoking 10–20 pack-years and eosinophil count < 300 cells/μL), 17 (3.7%); Group C (smoking ≥ 20 pack-years and eosinophil count ≥ 300 cells/μL), 341 (73.8%); and Group D (smoking ≥ 20 pack-years and eosinophil count < 300 cells/μL), 62 (13.4%). Age, sex, BDR, comorbidities, and medications significantly differed among the four groups.Conclusion: The prevalence of ACO differed between COPD and severe asthma cohorts. ACO patients can be classified into four phenotype groups, such that each phenotype exhibits distinct characteristics.

scholarly journals Th-2 signature in chronic airway diseases: towards the extinction of asthma−COPD overlap syndrome?

2017 ◽  
Vol 49 (5) ◽  
pp. 1602397 ◽  
Author(s):  
Borja G. Cosío ◽  
Luis Pérez de Llano ◽  
Antolin Lopez Viña ◽  
Alfons Torrego ◽  
Jose Luis Lopez-Campos ◽  
...  
Keyword(s):  
Eosinophil Count ◽  
Airway Disease ◽  
Obstructive Airway Disease ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Chronic Obstructive Airway Disease ◽  
Cross Sectional ◽  
Exacerbation Rate ◽  
Blood Eosinophil Count ◽  
Inflammatory Pattern

We aimed to describe the differences and similarities between patients with chronic obstructive airway disease classified on the basis of classical diagnostic labels (asthma, chronic obstructive pulmonary disease (COPD), or asthma–COPD overlap (ACOS)) or according to the underlying inflammatory pattern (Th-2 signature, either Th-2-high or Th-2-low).We performed a cross-sectional study of patients aged ≥40 years and with a post-bronchodilator forced expiratory volume in 1 s to forced vital capacity ratio ≤0.7 with a previous diagnosis of asthma (non-smoking asthmatics (NSA)), COPD or ACOS, the latter including both smoking asthmatics (SA) and patients with eosinophilic COPD (COPD-e). Clinical, functional and inflammatory parameters (blood eosinophil count, IgE and exhaled nitric oxide fraction (FeNO)) were compared between groups. Th-2 signature was defined by a blood eosinophil count ≥300 cells·μL−1 and/or a sputum eosinophil count ≥3%.Overall, 292 patients were included in the study: 89 with COPD, 94 NSA and 109 with ACOS (44 SA and 65 with COPD-e). No differences in symptoms or exacerbation rate were found between the three groups. With regards the underlying inflammatory pattern, 94 patients (32.2%) were characterised as Th-2-high and 198 (67.8%) as Th-2-low. The Th-2 signature was found in 49% of NSA, 3.3% of patients with COPD, 30% of SA and 49.3% of patients with COPD-e. This classification yielded significant differences in demographic, functional and inflammatory characteristics.We conclude that a classification based upon the inflammatory profile, irrespective of the taxonomy, provides a more clear distinction of patients with chronic obstructive airway disease.

scholarly journals New GOLD COPD Guideline 2019: How We Deal with It? (Inhaled Corticosteroid Use and Blood Eosinophil Count)

2021 ◽  
Vol 1 (2) ◽  
pp. 79-87
Author(s):  
Ari Julian Saputra ◽  
Kiki Widyastuti ◽  
Yusup Subagio Sutanto
Keyword(s):  
Eosinophil Count ◽  
Inhaled Corticosteroids ◽  
Low Cost ◽  
Smoking History ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Obstructive Pulmonary Disease ◽  
Blood Eosinophil Count ◽  
Blood Eosinophils ◽  
Group D

Background: Blood eosinophils may predict response to inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD), where ICS is recommended in patients at high risk of exacerbations by the Global Initiative for COPD (GOLD) strategy. It can help clinicians to estimate the likelihood of beneficial preventive responses to the addition ICS to regular bronchodilator treatment, and thus can be used as a biomarker in conjunction with clinical assessment when making decisions regarding ICS use. This study aims to compare therapeutic data with blood eosinophil count in COPD patients. Methods: Data were collected from consecutive COPD outpatients in Bukit Asam Medika Hospital starting from March 1st, 2019 until June 30th, 2019 and dr. H. Mohamad Rabain Hospital starting from Oct 1st, 2019 until Dec 27th, 2019. We collected demographics, anthropometrics, smoking history, therapy, dynamic lung volumes, the Medical Research Council scale (MRC), CAT score, and blood eosinophil count. Results: From 57 data collected, 24 (42,1%) patients were having blood eosinophil count ≥300. Patients who have more exacerbation in COPD Group C were 33,3% and 63,2% in COPD Group D. The proportions of ICS-treated COPD Group D patients and blood eosinophil count of <300 and ≥300 was 63,9% and 36,1%, respectively. Conclusion: This study may provide information and characteristic of COPD patient in Indonesia rural area and showed who may have benefit to ICS therapy based on recommendation GOLD COPD 2019. Blood eosinophils counts is a low-cost biomarker and may help clinicians to made decision therapy.

scholarly journals Comparative Efficacy and Safety of Dupilumab and Benralizumab in Patients with Inadequately Controlled Asthma: A Systematic Review

2020 ◽  
Vol 21 (3) ◽  
pp. 889 ◽  
Author(s):  
Koichi Ando ◽  
Akihiko Tanaka ◽  
Hironori Sagara
Keyword(s):  
Systematic Review ◽  
Eosinophil Count ◽  
Blood Eosinophil ◽  
Efficacy And Safety ◽  
Exacerbation Rate ◽  
Blood Eosinophil Count ◽  
Indirect Treatment Comparison ◽  
Treatment Comparison ◽  
Significant Difference ◽  
Indirect Treatment

No head-to-head trials have compared the efficacy and safety between the licensed dosage and administration dosage of dupilumab and benralizumab for inadequately controlled asthma. We conducted an indirect treatment comparison to estimate differences in the efficacy and safety between dupilumab and benralizumab for inadequately controlled asthma using the Bayesian approach. The primary efficacy endpoint was annual exacerbation rate (AER). A subgroup analysis by blood eosinophil count was also performed. The primary safety endpoint was the incidence of any adverse events (AAEs). The results demonstrate that there was no significant difference in the AER between dupilumab and benralizumab in overall patients and the subgroup with the blood eosinophil count of <150. However, the AER was significantly lower in the dupilumab group than in the benralizumab group in the subgroup with a blood eosinophil count of ≥150 but <300, and ≥300 with the rate ratio and 95% credible interval of 0.51 (0.29–0.92) and 0.58 (0.39–0.84), respectively. There was no significant difference in the AAEs between the dupilumab and benralizumab groups. This indirect treatment comparison indicates that dupilumab is superior to benralizumab in patients with inadequately controlled asthma having higher blood eosinophil counts. A direct comparison is required to provide definitive evidence. Systematic Review Registration: UMIN-CTR no. UMIN000036256.

scholarly journals Prevalence of Asthma and COPD and Blood Eosinophil Count in a Middle-Aged Belgian Population

2019 ◽  
Vol 8 (8) ◽  
pp. 1122 ◽  
Author(s):  
Sara R. A. Wijnant ◽  
Lies Lahousse ◽  
Marc L. De Buyzere ◽  
Guy G. Brusselle ◽  
Ernst R. Rietzschel
Keyword(s):  
Eosinophil Count ◽  
Respiratory Health ◽  
Disease Status ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Middle Aged ◽  
Blood Eosinophil Count ◽  
Current Asthma ◽  
Airway Diseases ◽  
Obstructive Airway Diseases

Various phenotypes exist in asthma and Chronic Obstructive Pulmonary Disease (COPD). These are important to identify in order to guide treatment decisions. We aim to investigate the prevalence and clinical characteristics of obstructive airway diseases in the middle-aged population. We estimated the prevalence of COPD and/or asthma in the Asklepios cohort study (Belgium), using information from the third European Community Respiratory Health Survey (ECRHS3), medical records, and spirometry. Respiratory symptoms, respiratory medication, and current disease status distinguished clinical from sub-clinical cases. In addition, we compared the blood eosinophil count/µL (median [IQR]) between cases and controls. Of the 2221 participants (mean age 56.1 ± 5.9 years; 48.7% males), 138 (6.2%) participants had clinical current asthma, 22 (1.0%) participants had sub-clinical ever asthma, 102 (4.6%) had sub-clinical spirometry-defined COPD, 104 (4.6%) participants had clinical spirometry-confirmed COPD, and 11 (0.5%) had asthma and COPD overlap (ACO). Clinical current asthma (160.0 [110.0–250.0]), sub-clinical ever asthma (170.0 [110.0–230.0]), and clinical COPD (160.0 [110.0–220.0])—but less sub-clinical COPD (140.0 [90.0–210.0])—had higher eosinophil counts, compared to controls (130.0 [80.0–200.0]). We conclude that obstructive airway diseases are prevalent in the middle-aged Asklepios cohort. Moreover, the systemic eosinophil count is increased in clinical COPD cases, and in asthma cases regardless of clinical remission.

scholarly journals Omalizumab effectiveness in patients with severe allergic asthma according to blood eosinophil count: the STELLAIR study

2018 ◽  
Vol 51 (5) ◽  
pp. 1702523 ◽  
Author(s):  
Marc Humbert ◽  
Camille Taillé ◽  
Laurence Mala ◽  
Vincent Le Gros ◽  
Jocelyne Just ◽  
...  
Keyword(s):  
Allergic Asthma ◽  
Eosinophil Count ◽  
Response Rate ◽  
Real Life ◽  
Blood Eosinophil ◽  
Exacerbation Rate ◽  
Blood Eosinophil Count ◽  
Life Study ◽  
Severe Allergic Asthma ◽  
Blood Eosinophils

Omalizumab is a monoclonal anti-IgE antibody used to treat severe allergic asthma (SAA). The aim of the STELLAIR study was to determine the importance of pre-treatment blood eosinophil count as a predictive measure for response to omalizumab.This retrospective real-life study was conducted in France between December 2015 and September 2016 using medical records of SAA omalizumab-treated patients. Response to omalizumab was assessed by three criteria: physician evaluation, reduction of ≥40% in annual exacerbation rate and a combination of both. Response rate was calculated according to blood eosinophil count measured in the year prior to omalizumab initiation.872 SAA omalizumab-treated patients were included by 78 physicians (723 adults (age ≥18 years) and 149 minors (age 6–17 years)). Blood eosinophil count was ≥300 cells·µL−1 in 52.1% of adults and 73.8% of minors. By physician evaluation, 67.2% of adults and 77.2% of minors were responders and 71.1% adults and 78.5% minors had a ≥40% reduction in the exacerbation rate. In adults, the response rate for combined criteria was 58.4% (95% CI 53.2–63.4%) for blood eosinophils ≥300 cells·µL−1 (n=377) and 58.1% (95% CI 52.7–63.4%) for blood eosinophils <300 cells·µL−1 (n=346).This study shows that a large proportion of patients with SAA have a blood eosinophil count ≥300 cells·µL−1, and suggests that omalizumab effectiveness is similar in “high” and “low” eosinophil subgroups.

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