Blood Eosinophils and Exacerbations in Chronic Obstructive Pulmonary Disease. The Copenhagen General Population Study

Vedel-Krogh, Signe; Nielsen, Sune F.; Lange, Peter; Vestbo, Jørgen; Nordestgaard, Børge G.

doi:10.1164/rccm.201509-1869oc

Cited by 352 publications

(373 citation statements)

References 22 publications

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“…Some studies 155,157 have shown a better response in patients with blood eosinophils 2% while in other studies 159 a cut-off of 4% or eosinophil count >300 cells/mL has been suggested. Data suggests that in COPD, blood eosinophil levels >340 cells/mL is associated with a 1.76 fold increased risk of severe exacerbations 160 ; however using the 2% cut-off in this study did not predict increased risk of exacerbations. Finally, blood eosinophils demonstrated reasonable repeatability over 1 year in a population-based cohort of COPD patients in primary care.…”

Section: Summary Of Evidencecontrasting

confidence: 78%

CTS position statement: Pharmacotherapy in patients with COPD—An update

Bourbeau

Bhutani

Hernández

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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RATIONALE: Since the last published Canadian Thoracic Society (CTS) COPD guideline in 2007 and the 2008 update -highlights for primary care, many new clinical trials have challenged COPD treatment practices. The current Canadian position statement provides the reader with an update on pharmacotherapy of patients with COPD as reviewed by the CTS. OBJECTIVES: The objectives of this position statement are: 1) to summarize the literature on topics relevant to the pharmacological therapy of patients with stable COPD; and 2) to provide clinical guidance with evidence-based recommendations and expert-informed key messages for the pharmacological therapy for patients with stable COPD. METHODS: The authors systematically reviewed the relevant literature focusing on randomized controlled trials and when available, systematic reviews of randomized controlled trials. The proposed key messages, based on scientific evidence and expert-informed opinion, were agreed upon by a majority consensus. MAIN RESULTS: There is typically a significant delay in seeking medical care by patients with dyspnea, often waiting until symptoms affect the performance of activities of daily living. The diagnosis of COPD requires spirometry to confirm the presence of airflow obstruction in any patient presenting with symptoms and/or risk factors of COPD. An effective management plan for individuals with COPD should include: smoking cessation, vaccination and education. A number of non-pharmacological treatments are available for COPD patients with symptoms to improve outcomes such as self-management with coaching from a health care professional; pulmonary rehabilitation; supplemental oxygen in selected patients; and surgery.Current pharmacotherapy for COPD has been shown to alleviate symptoms and prevent exacerbations and related complications such as hospital admissions. In symptomatic patients with stable COPD not having or having infrequent exacerbation, treatment should be started with inhaled LAMA or LABA monotherapy, and if experiencing persistent or increased dyspnea, exercise intolerance, and/or reduced health status despite use of monotherapy, patients should be considered for treatment "step up" with an inhaled LAMA plus LABA dual therapy. In this situation, the use of a single inhaler would be preferred to simplify the treatment regimen and minimize the cost. In patients with stable COPD experiencing exacerbations despite the use of LAMA or LABA monotherapy, treatment "step up" with inhaled LAMA plus LABA dual therapy should be considered unless a patient has concomitant asthma (Asthma/COPD overlap (ACO)). There has been recent interest in using biomarkers to identify patients who are more likely to respond to ICS. Most of the studies have demonstrated that high blood eosinophils could be valuable to predict an increase response in terms of reduction of exacerbation rate when treated with combination ICS/LABA; there is still uncertainty about the exact cut-off level of blood eosinophils having potential therapeutic value. If a pa...

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Section: Summary Of Evidencecontrasting

confidence: 78%

CTS position statement: Pharmacotherapy in patients with COPD—An update

Bourbeau

Bhutani

Hernández

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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“…The role of eosinophils in COPD has thus raised a number of questions and thus the study published in this issue of AJRCCM by Vedel-Krogh and colleagues is of considerable interest (7). This is a large and important study as it describes blood eosinophil counts in COPD patients in the general population using the Copenhagen General Population Study.…”

mentioning

confidence: 99%

“…Some relationship has been found between airway and blood eosinophils in COPD but the associations are generally weak (12). In the Copenhagen study, COPD patients with higher blood eosinophil counts were more likely to have reported more infections and wheezing during colds, suggesting they may have had increased susceptibility to viral infection (7). The increased blood eosinophil count may reflect a past history of more frequent exacerbations with respiratory viruses and studies are now required to investigate in more detail how eosinophilia is related to viral susceptibility, different degrees of exacerbation frequency and exacerbation recovery.…”

mentioning

confidence: 99%

Eosinophils as Biomarkers of Chronic Obstructive Pulmonary Disease Exacerbation Risk. Maybe Just for Some?

Wedzicha

2016

Am J Respir Crit Care Med

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“…Several reports have suggested that high sputum and blood eosinophil counts in patients with COPD are associated with specific clinical phenotypes defined by 1) more frequent exacerbations and 2) better response to inhaled corticosteroids (ICS) for exacerbation prevention [5] [6] [7] [8] [9]. In addition, ICS therapy may reduce the rate of decline of forced expiratory volume in 1 second (FEV1) in patients with high blood eosinophil counts [10].…”

Section: Introductionmentioning

confidence: 99%

Usefulness of Fractional Exhaled Nitric Oxide-Guided Treatment in Patients with Asthma-Chronic Obstructive Pulmonary Disease Overlap

Akamatsu¹,

Shirai²,

Tanaka³

et al. 2018

OJRD

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Background: Some patients present clinical features of both asthma and chronic obstructive pulmonary disease (COPD), which has led to the recent proposal of asthma-COPD overlap (ACO) as a diagnosis. Fractional exhaled nitric oxide (FeNO) is a candidate biomarker to diagnose ACO. We assessed the effect of an add-on treatment with budesonide/formoterol (BUD/FM) combination in patients with ACO, which was diagnosed by FeNO. Methods: This was a prospective, single-arm, open-label, before and after comparison study. Subjects included 83 patients with COPD who attended outpatient clinics for routine checkups at Shizuoka General Hospital between June and November 2016. All patients fulfilled the GOLD definition of COPD and were receiving long-acting muscarinic antagonist (LAMA) or LAMA/long-acting β 2 agonist (LABA) combinations. After an 8-week run-in period, BUD/FM was added to the patients with FeNO levels of ≥35 ppb, defined as having ACO. For patients receiving LAMA/LABA, BUD/FM was added after the discontinuation of LABA. The modified British Medical Research Council (mMRC) score, COPD assessment test (CAT) score, spirometric indices, forced oscillation parameters, and FeNO were assessed before and after 8 weeks of BUD/ FM add-on treatment. Results: Twenty-four patients (28.9%) had FeNO levels ≥ 35 ppb, and 17 patients completed the study (mean age: 73 years and GOLD I/II/III/IV, 5/10/1/1). The mean CAT scores significantly improved (9.2 to 5.4, p = 0.015) and 10 patients (58.8%) showed ≥2 points improvement, a minimal clinically important difference. The mean FeNO levels significantly decreased from 63.0 to 34.3 ppb (p < 0.006). However, there were no changes in mMRC

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Blood Eosinophils and Exacerbations in Chronic Obstructive Pulmonary Disease. The Copenhagen General Population Study

Abstract: Among individuals with COPD in the general population, increased blood eosinophil levels above 0.34 × 10(9) cells per liter were associated with a 1.76-fold increased risk of severe exacerbations.

Cited by 352 publications

References 22 publications

CTS position statement: Pharmacotherapy in patients with COPD—An update

CTS position statement: Pharmacotherapy in patients with COPD—An update

Eosinophils as Biomarkers of Chronic Obstructive Pulmonary Disease Exacerbation Risk. Maybe Just for Some?

Usefulness of Fractional Exhaled Nitric Oxide-Guided Treatment in Patients with Asthma-Chronic Obstructive Pulmonary Disease Overlap

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