Eosinophilia as a treatable trait in three patients with asthma and COPD

Abstract

The combination of asthma and chronic obstructive pulmonary disease (COPD) in an individual can present significant challenges to achieving satisfactory outcomes. More recently, the concepts of precision medicine and treatable traits have arisen as promising tools to improve care for this group. In this series, we present three cases of patients with features of both asthma and COPD in addition to peripheral blood eosinophilia. The novel implementation of personalized management of the individual based on this treatable trait (eosinophilia) resulted in significant benefits. These benefits included improvement in symptoms, lung function, and a marked decline in critical care admissions and exacerbation rates.

Asthma-COPD overlap: current understanding and the utility of experimental models

“…Biomarkers including fractional exhaled nitric oxide [38,41], eosinophil counts in peripheral blood [39][40][41] or sputum [37,38,41] and serum IgE levels [37][38][39]41] have been investigated across different cohorts of patients with ACO. Blood eosinophil counts have been identified as a predictor of response to inhaled corticosteroid (ICS) treatment in COPD [50][51][52]. Consequently, the 2019 GOLD guidelines recommend ICS treatment for patients with COPD with blood eosinophil count ⩾300 cells•µL −1 (and consider ICS treatment for 100-300 cells•µL −1 ); however, blood eosinophil count data needs to take into account exacerbation severity and frequency for accurate interpretation [6].…”