A systematic review of blood eosinophils and continued treatment with inhaled corticosteroids in patients with COPD

Dalin, Dagmar Abelone; Løkke, Anders; Kristiansen, Pernille; Jensen, Charlotte Harken; Birkefoss, Kirsten; Christensen, Hanne; Godtfredsen, Nina; Hilberg, Ole; Rohde, Jeanett Friis; Ussing, Anja; Vermehren, Charlotte; Händel, Mina Nicole

doi:10.1016/j.rmed.2022.106880

Cited by 7 publications

(6 citation statements)

References 43 publications

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“… 14 Many studies such as SUNSET, WISDOM and SPIROMICS have reported exacerbations correlating with blood eosinophils. 15 , 16 , 42 , 43 In our dataset, the proportion of high eosinophils in patients without severe exacerbation was approximately 1.7 times greater than that in the severe exacerbation group, and low eosinophil percentage was associated with increased 12-month COPD-related readmission before and after adjustment. Unlike our study, the SUNSET study reported that patients with higher blood eosinophils had a higher risk of future exacerbations, but their enrolled patients were stable COPD with a history of tobacco use and the endpoint was moderate or severe exacerbations.…”

Section: Discussionmentioning

confidence: 72%

Characteristics of 12-Month Readmission for Hospitalized Patients with COPD: A Propensity Score Matched Analysis of Prospective Multicenter Study

Xu¹,

Sun²,

Zhao³

et al. 2022

COPD

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Purpose Hospitalization for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is considered as severe exacerbations. Readmission for severe exacerbations is a crucial event for COPD patients. However, factors associated with readmission for severe exacerbations are incomplete. The study aimed to investigate different characteristics between the severe and non-severe exacerbation groups. Patients and Methods Patients hospitalized for severe AECOPD were included in multi-centers, and their exacerbations in next 12 months after discharge were recorded. According to exacerbations, patients were separated into the severe-exacerbation group and the non-severe exacerbation group. Propensity-score matching (PSM) and multivariable analyses were performed to compare the baseline characteristics of two groups. The Hosmer-Lemeshow test and receiver operating characteristic curve were applied to evaluate how well the model could identify clusters. Results The cohort included 550 patients with severe AECOPD across 27 study centers in China, and 465 patients were finally analyzed. A total of 41.5% of patients underwent readmission for AECOPD within 1 year. There were no significant differences in baseline characteristics between groups after PSM. Severe exacerbations in the 12 months were related to some factors, eg, the duration of COPD (13 vs 8 years, P <0.001), the COPD Assessment Test (CAT) score (20 vs 17, P <0.001), the blood eosinophil percentage (1.5 vs 2.0, P <0.05), and their inhaler therapies. Patients readmitted with AECOPD had a longer time of diagnosis (≥9 years), more symptoms (CAT ≥10), and lower blood eosinophils (Eos <2%). A clinical model was derived to help identify patients at risk of readmission with severe exacerbations. Conclusion These analyses confirmed the relevance of COPD at admission with future severe exacerbations. A lower blood eosinophils percentage appears to be related to readmission when combined with clinical history. Further studies are needed to evaluate whether this study can predict the risk of exacerbations.

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Section: Discussionmentioning

confidence: 72%

Characteristics of 12-Month Readmission for Hospitalized Patients with COPD: A Propensity Score Matched Analysis of Prospective Multicenter Study

Xu¹,

Sun²,

Zhao³

et al. 2022

COPD

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“…A meta–analysis by Dalin et al. ( 37 ) suggests that ICS treatment appears beneficial for all patients except those with blood eosinophil counts <150 cells/μL. Similarly, Ashdown et al.…”

Section: Discussionmentioning

confidence: 96%

Optimizing inhaled corticosteroid use in patients with chronic obstructive pulmonary disease: assessing blood eosinophils, neutrophil–to–lymphocyte ratio, and mortality outcomes in US adults

Hu,

Wang,

Jian

et al. 2023

Front. Immunol.

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ObjectiveAccurate biomarkers for evaluating mortality rates in patients with chronic obstructive pulmonary disease (COPD) remain scarce. This study aimed to explore the relationships between mortality rates in patients with COPD and blood eosinophil counts, neutrophil counts, and lymphocyte counts, along with the neutrophil–to–lymphocyte ratio (NLR). Additionally, we sought to identify the optimal response values for these biomarkers when utilizing inhaled corticosteroids (ICS).MethodsUtilizing a nationally representative, multistage cross–sectional design and mortality correlation study, we analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999–2018 involving US adults aged 40 years or older with COPD. The primary endpoint was all–cause mortality, with Kaplan–Meier survival curves and restricted cubic splines applied to illustrate the relationship between leukocyte–based inflammatory markers and mortality. The analysis was conducted in 2023.ResultsOur analysis included 1,715 COPD participants, representing 6,976,232 non–institutionalized US residents [weighted mean age (SE), 62.09 (0.28) years; range, 40–85 years]. Among the participants, men constituted 50.8% of the population, and the weighted mean follow–up duration was 84.9 months. In the ICS use group, the weighted proportion of participants over 70 years old was significantly higher compared with the non–ICS use group (31.39% vs 25.52%, p < 0.0001). The adjusted hazard ratios for all–cause mortality related to neutrophil counts, lymphocyte counts, and NLR were 1.10 [95% confidence interval (CI), 1.04–1.16, p < 0.001], 0.83 (95% CI, 0.71–0.98; p = 0.03), and 1.10 (95% CI, 1.05–1.15; p < 0.0001), respectively. Optimal ICS response was linked with higher levels of eosinophil count (≥240 cells/μL), neutrophil count (≥3,800 cells/μL), NLR (≥4.79), and lower levels of lymphocyte count (<2,400 cells/μL).ConclusionAdjusted baseline neutrophil, lymphocyte counts, and NLR serve as independent risk factors for all–cause mortality in patients with COPD. Further, ICS application appears to mitigate mortality risk, particularly when NLR levels reach 4.79 or higher, underlining the importance of ICS in COPD management.Graphical abstractInhaled Corticosteroid Use in COPD: A Comparative Analysis of Leukocyte-based Inflammatory Markers and Mortality Outcomes Based on NHANES Data (1999-2018).

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“…Indeed, use of ICS-containing medications in patients with high blood eosinophil counts (≥ 150 cells/μL) is associated with improvement in FEV 1 . 49 Therefore, blood eosinophil counts are useful in predicting the magnitude of the effect of ICS and serve in the selection of effective COPD management strategies. 1…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Frequency of Chronic Obstructive Pulmonary Disease Exacerbations in Korean Patients: Findings From the KOCOSS Cohort 2012–2021

Rhee,

Choi,

Park

et al. 2024

J Korean Med Sci

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Background Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) exert a substantial burden on patients and healthcare systems; however, data related to the frequency of AECOPD in the Korean population are limited. Therefore, this study aimed to describe the frequency of severe, and moderate or severe AECOPD, as well as clinical and demographic characteristics of patients with chronic obstructive pulmonary disease (COPD) in South Korea. Methods Data from patients aged > 40 years with post-bronchodilator forced expiratory volume in 1 second (FEV 1 )/forced vital capacity ≤ 70% of the normal predicted value from the Korea COPD Subgroup Study database were analyzed (April 2012 to 2021). The protocol was based on the EXAcerbations of COPD and their OutcomeS International study. Data were collected retrospectively for year 0 (0–12 months before study enrollment) based on patient recall, and prospectively during years 1, 2, and 3 (0–12, 13–24, and 25–36 months after study enrollment, respectively). The data were summarized using descriptive statistics. Results Data from 3,477 Korean patients (mean age, 68.5 years) with COPD were analyzed. Overall, most patients were male (92.3%), former or current smokers (90.8%), had a modified Medical Research Council dyspnea scale score ≥ 1 (83.3%), and had moderate airflow limitation (54.4%). The mean body mass index (BMI) of the study population was 23.1 kg/m 2 , and 27.6% were obese or overweight. Hypertension was the most common comorbidity (37.6%). The mean blood eosinophil count was 226.8 cells/μL, with 21.9% of patients having ≥ 300 cells/μL. A clinically insignificant change in FEV 1 (+1.4%) was observed a year after enrollment. Overall, patients experienced a mean of 0.2 severe annual AECOPD and approximately 1.1 mean moderate or severe AECOPD. Notably, the rates of severe AECOPD remained generally consistent over time. Compared with patients with no exacerbations, patients who experienced severe exacerbations had a lower mean BMI (21.7 vs. 23.1 kg/m 2 ; P < 0.001) and lower lung function parameters (all P values < 0.001), but reported high rates of depression (25.5% vs. 15.1%; P = 0.044) and anxiety (37.3% vs. 16.7%; P < 0.001) as a comorbidity. Conclusion Findings from this Korean cohort of patients with COPD indicated a high exacerbation burden, which may be attributable to the unique characteristics of the study population and suboptimal disease management. This highlights the need to align clinical practices with the latest treatment recommendations to alleviate AECOPD burden in Korea. Trial Registration ClinicalTrials.gov Identifier: NCT05750810

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A systematic review of blood eosinophils and continued treatment with inhaled corticosteroids in patients with COPD

Cited by 7 publications

References 43 publications

Characteristics of 12-Month Readmission for Hospitalized Patients with COPD: A Propensity Score Matched Analysis of Prospective Multicenter Study

Characteristics of 12-Month Readmission for Hospitalized Patients with COPD: A Propensity Score Matched Analysis of Prospective Multicenter Study

Optimizing inhaled corticosteroid use in patients with chronic obstructive pulmonary disease: assessing blood eosinophils, neutrophil–to–lymphocyte ratio, and mortality outcomes in US adults

Clinical Characteristics and Frequency of Chronic Obstructive Pulmonary Disease Exacerbations in Korean Patients: Findings From the KOCOSS Cohort 2012–2021

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