scholarly journals Shall We Focus on the Eosinophil to Guide Treatment with Systemic Corticosteroids during Acute Exacerbations of COPD?: PRO

2018 ◽  
Vol 6 (3) ◽  
pp. 74 ◽  
Author(s):  
James Camp ◽  
Jennifer Cane ◽  
Mona Bafadhel
Keyword(s):  
Precision Medicine ◽  
Corticosteroid Treatment ◽  
Airway Disease ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Correct Identification ◽  
Obstructive Pulmonary Disease ◽  
Peripheral Blood Eosinophil ◽  
Increased Risk ◽  
Oral Corticosteroids

In an era of precision medicine, it seems regressive that we do not use stratified approaches to direct treatment of oral corticosteroids during an exacerbation of chronic obstructive pulmonary disease (COPD). This is despite evidence suggesting that 40% of COPD patients have eosinophilic inflammation and this is an indicator of corticosteroid response. Treatments with oral corticosteroids are not always effective and not without harm, with significant and increased risk of hyperglycemia, sepsis, and fractures. Eosinophils are innate immune cells with an incompletely understood role in the pathology of airway disease. They are detected at increased levels in some patients and can be measured using non-invasive methods during states of exacerbation and stable periods. Despite the eosinophil having an unknown mechanism in COPD, it has been shown to be a marker of length of stay in severe hospitalized exacerbations, a predictor of risk of future exacerbation and exacerbation type. Although limited, promising data has come from one prospective clinical trial investigating the eosinophil as a biomarker to direct systemic corticosteroid treatment. This identified that there were statistically significant and clinically worsened symptoms in patients with low eosinophil levels who were prescribed prednisolone, demonstrating the potential utility of the eosinophil. In an era of precision medicine our patients’ needs are best served by accurate diagnosis, correct identification of maximal treatment response and the abolition of harm. The peripheral blood eosinophil count could be used towards reaching these aims.

scholarly journals Airway inflammation in COPD: progress to precision medicine

2019 ◽  
Vol 54 (2) ◽  
pp. 1900651 ◽  
Author(s):  
Christopher Brightling ◽  
Neil Greening
Keyword(s):  
Precision Medicine ◽  
Airway Inflammation ◽  
Severe Disease ◽  
Chronic Obstructive ◽  
Inflammasome Activation ◽  
Eosinophilic Inflammation ◽  
Obstructive Pulmonary Disease ◽  
Interleukin 5 ◽  
Increased Risk ◽  
Anti Inflammatory

Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality worldwide, and its prevalence is increasing. Airway inflammation is a consistent feature of COPD and is implicated in the pathogenesis and progression of COPD, but anti-inflammatory therapy is not first-line treatment. The inflammation has many guises and phenotyping this heterogeneity has revealed different patterns. Neutrophil-associated COPD with activation of the inflammasome, T1 and T17 immunity is the most common phenotype with eosinophil-associated T2-mediated immunity in a minority and autoimmunity observed in more severe disease. Biomarkers have enabled targeted anti-inflammatory strategies and revealed that corticosteroids are most effective in those with evidence of eosinophilic inflammation, whereas, in contrast to severe asthma, response to anti-interleukin-5 biologicals in COPD has been disappointing, with smaller benefits for the same intensity of eosinophilic inflammation questioning its role in COPD. Biological therapies beyond T2-mediated inflammation have not demonstrated benefit and in some cases increased risk of infection, suggesting that neutrophilic inflammation and inflammasome activation might be largely driven by bacterial colonisation and dysbiosis. Herein we describe current and future biomarker approaches to assess inflammation in COPD and how this might reveal tractable approaches to precision medicine and unmask important host–environment interactions leading to airway inflammation.

scholarly journals Treatable traits in an English cohort: Prevalence and predictors of future decline in lung function and quality of life in COPD

2021 ◽  
pp. 00934-2020
Author(s):  
Muhammad Rehan Sarwar ◽  
Vanessa Marie McDonald ◽  
Michael John Abramson ◽  
Eldho Paul ◽  
Johnson George
Keyword(s):  
Quality Of Life ◽  
Lung Function ◽  
Precision Medicine ◽  
Airway Disease ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Lifestyle Risk Factors ◽  
The Core

Background“Treatable traits (TTs)” is a precision medicine approach for facilitating multidimensional assessment of every patient with chronic airway disease to determine the core traits associated with disease outcomes, where targeted treatments are applied.ObjectivesTo determine the prevalence of TTs in chronic obstructive pulmonary disease (COPD) and which traits predict future decline in lung function and quality of life (QoL).MethodsA 4 year longitudinal evaluation was conducted using data from 3726 participants in the English Longitudinal Study of Ageing (ELSA). TTs were identified based on published recommendations. Traits that predicted decline in lung function and QoL were analysed using generalised estimating equations.ResultsOverall, 21 TTs, including pulmonary (n=5), extra-pulmonary (n=13) and behavioural/lifestyle risk-factors (n=3) were identified. In multivariate analyses, traits of chronic bronchitis (β=−0.186; 95%CI=−0.290 to −0.082), breathlessness (β=−0.093; 95%CI=−0.164 to −0.022), underweight (β=−0.216; 95%CI=−0.373 to −0.058), sarcopaenia (β=−0.162; 95%CI=−0.262 to −0.061), and current smoking (β=−0.228; 95%CI=−0.304 to −0.153), predicted decline in forced expiratory volume in 1 s (FEV1). Of the seven traits that predicted decline in QoL, depression (β=−7.19; 95%CI=−8.81 to −5.57) and poor family and social support (β=−5.12; 95%CI=−6.65 to −3.59) were the strongest.ConclusionThe core TTs of COPD associated with a decline in lung function and QoL were identified. Targeting these impactful traits and individualised treatment using a precision medicine approach may improve outcomes in people with COPD.

scholarly journals Oral Corticosteroid Use and the Risk of Acute Myocardial Infarction in Chronic Obstructive Pulmonary Disease

2006 ◽  
Vol 13 (3) ◽  
pp. 134-138 ◽  
Author(s):  
Laetitia Huiart ◽  
Pierre Ernst ◽  
Xavier Ranouil ◽  
Samy Suissa
Keyword(s):  
Myocardial Infarction ◽  
Chronic Obstructive Pulmonary Disease ◽  
Acute Myocardial Infarction ◽  
Pulmonary Disease ◽  
Systemic Hypertension ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Increased Risk ◽  
Acute Exacerbations ◽  
Oral Corticosteroids

BACKGROUND: Given the limited efficacy of oral corticosteroids in treating chronic obstructive pulmonary disease (COPD), the possible cardiac side effects of oral corticosteroids are of particular concern in an elderly population. The impact of the use of oral corticosteroids on the risk of acute myocardial infarction (AMI) in a cohort of patients with COPD was studied.METHODS: The Saskatchewan health services databases were used to form a population-based cohort of 5648 patients aged 55 years or older who received a first treatment for COPD between 1990 and 1997. A nested case-control analysis was conducted: 371 cases presenting with a first myocardial infarction were matched with 1864 controls according to the length of follow-up, the date of cohort entry and age. Conditional logistic regression was used to adjust for sex, severity of COPD, systemic hypertension, diabetes and prior cardiovascular disease.RESULTS: Only the current use of corticosteroids was associated with an increased risk of AMI (adjusted RR=2.01 [95% CI 1.13 to 3.58]), particularly when the current dose was larger than 25 mg/day of prednisone or the equivalent (adjusted RR=3.22 [95% CI 1.42 to 7.34]). This observed increase in risk rapidly returned to baseline after the cessation of the medication, suggesting that the use of such high doses reflected the treatment of acute exacerbations of the disease.CONCLUSIONS: An association was found between the current use of oral corticosteroids and the occurrence of an AMI, suggesting that acute exacerbations of COPD are associated with an increased risk of acute coronary syndromes.

scholarly journals Impact and associations of eosinophilic inflammation in COPD: analysis of the AERIS cohort

2017 ◽  
Vol 50 (4) ◽  
pp. 1700853 ◽  
Author(s):  
Viktoriya L. Kim ◽  
Ngaire A. Coombs ◽  
Karl J. Staples ◽  
Kristoffer K. Ostridge ◽  
Nicholas P. Williams ◽  
...  
Keyword(s):  
Stable State ◽  
Area Under The Curve ◽  
Response To Treatment ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Eosinophilic Inflammation ◽  
Obstructive Pulmonary Disease ◽  
Increased Risk ◽  
New Treatment ◽  
The Stability

Eosinophilic inflammation in chronic obstructive pulmonary disease (COPD) predicts response to treatment, especially corticosteroids. We studied the nature of eosinophilic inflammation in COPD prospectively to examine the stability of this phenotype and its dynamics across exacerbations, and its associations with clinical phenotype, exacerbations and infection.127 patients aged 40–85 years with moderate to very severe COPD underwent repeated blood and sputum sampling at stable visits and within 72 h of exacerbation for 1 year.Blood eosinophils ≥2% was prevalent at baseline, and predicted both predominantly raised stable-state eosinophils across the year (area under the curve 0.841, 95% CI 0.755–0.928) and increased risk of eosinophilic inflammation at exacerbation (OR 9.16; p<0.001). Eosinophils ≥2% at exacerbation and eosinophil predominance at stable visits were associated with a lower risk of bacterial presence at exacerbation (OR 0.49; p=0.049 and OR 0.25; p=0.065, respectively). Bacterial infection at exacerbation was highly seasonal (winter versus summer OR 4.74; p=0.011) in predominantly eosinophilic patients.Eosinophilic inflammation is a common and stable phenotype in COPD. Blood eosinophil counts in the stable state can predict the nature of inflammation at future exacerbations, which when combined with an understanding of seasonal variation provides the basis for the development of new treatment paradigms for this important condition.

scholarly journals Systemic Corticosteroids and the Risk of Venous Thromboembolism in Patients with Severe COPD: A Nationwide Study Of 30,473 Outpatients

Biomedicines ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 874
Author(s):  
Ema Rastoder ◽  
Pradeesh Sivapalan ◽  
Josefin Eklöf ◽  
Mohamad Isam Saeed ◽  
Alexander Svorre Jordan ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Absolute Risk ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Systemic Corticosteroids ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Oral Corticosteroids ◽  
Cox Proportional Hazard Regression ◽  
Exacerbation Of Copd

Due to frequent exacerbations, many patients with chronic obstructive pulmonary disease (COPD) are exposed to oral corticosteroids (OCS), which may be thrombogenic. We evaluated the risk of hospitalisation with venous thromboembolism (VTE) and death in patients with acute exacerbation of COPD (AECOPD) treated with long and short OCS regimens. In this nationwide cohort study of 30,473 COPD outpatients treated for AECOPD, we compared the risk of VTE hospitalisation and all-cause mortality within 6 months in OCS dose of > 250 mg vs. ≤ 250 mg. A multivariable Cox proportional hazard regression was used to estimate the risk. The incidence of VTE hospitalisations was 0.23%. A long OCS treatment course was associated with an increased risk of VTE compared to a short course (hazard ratio (HR) 1.69, [95% confidence interval (CI) 1.05 to 2.72], p < 0.031). A higher risk of all-cause mortality was seen in the group of COPD patients treated with a long OCS course (HR 1.71, [95% CI 1.63 to 1.79], p < 0.0001). The risk of reported VTE hospitalisation was higher among AECOPD patients treated with long courses of OCS, but the absolute risk was low, suggesting under-reporting of the condition.

scholarly journals Elevated Peripheral Blood Eosinophils (PBE) During Acute Exacerbation of COPD (AECOPD)

2021 ◽  
Author(s):  
Mitha Al Sibani ◽  
Abdullah M. Al Alawi ◽  
Jamal Al Aghbari
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Peripheral Blood ◽  
Eosinophil Count ◽  
Length Of Hospital Stay ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Obstructive Pulmonary Disease ◽  
Increased Risk

Objectives: An elevated peripheral blood eosinophil (PBE) count during acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a potential predictor of treatment responsiveness and future exacerbation risk. This study aimed to evaluate the prevalence and clinical significance of elevated PBE counts in hospitalized patients with AECOPD in Oman. Methods: This single-center retrospective study included all patients with AECOPD who were admitted to Sultan Qaboos University Hospital between January 2017 and July 2019. The patients were classified as having eosinophilic or noneosinophilic AECOPD based on blood eosinophil counts. An elevated eosinophil count was defined as a blood eosinophil count > 0.3 × 109 cells/L on admission. The length of hospital stay, use of oral and inhaled steroids, number of readmissions in a year, and use of mechanical ventilation on admission were compared between the eosinophilic and non-eosinophilic AECOPD groups. Results: Of the 102 patients included in the study, 42.2% had eosinophilic AECOPD. The eosinophilic AECOPD group had a reduced length of hospital stay (P = 0.02) but an increased risk of readmission in a year (P = 0.04). Most patients in both the groups were treated with inhaled and oral steroids. The need for mechanical ventilation did not differ between the groups. Conclusion: Eosinophilia is highly prevalent in patients with AECOPD and is associated with a reduced length of hospital stay but an increased risk of readmission in a year. It can be used as a surrogate marker to predict the health outcomes of patients with AECOPD and select treatment options. Keywords: Chronic Obstructive Pulmonary disease (COPD); Eosinophils; Steroids; length of stay; hospital readmission.

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