Eosinophilic phenotype was associated with better early clinical remission in elderly patients but not middle‐aged patients with acute exacerbations of COPD

Abstract

Background There is limited evidence of the relationship between peripheral blood eosinophils and clinical remission of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) at different ages, especially in elderly patients, which was the objective of the present study. Methods This retrospective study stratified patients by age (elderly patients >65 years old or middle‐aged patients between 45 and 65 years old) and analysed the relationship between blood eosinophils (≥2% or <2%) and AECOPD clinical remission at observing time points of 7, 14, 21 and 28 days of hospitalisation. Student's t tests, Mann–Whitney U tests, Chi‐squared or Fisher's exact tests were conditionally used to compare difference between groups. The unadjusted or adjusted Cox proportional hazards model was used to analyse the association between blood eosinophilic levels and cumulative clinical remission. Results Of 703 AECOPD cases analysed, 616 were elderly people (>65 years), 312 of whom had eosinophilic exacerbations. There were statistically significant differences in leucocytes, eosinophils, neutrophils, lymphocytes, monocytes, high‐sensitivity C‐reactive protein levels (hs‐CRP), and hospital costs between groups (P < .05, respectively). According to the chi‐square analysis, eosinophilic exacerbation had a higher clinical remission rate at 7, 14 and 21 days (all P < .05), but not 28 days (P > .05). Among analysis through adjusted Cox proportional hazards model, eosinophilic exacerbation was significantly associated with a higher cumulative remission rate in elderly patients at 7, 14, 21 days (all P < .05), but not 28 days (P > .05). No significant association was observed in meddle‐aged patients at any time points (all P > .05). Conclusion Eosinophilic exacerbation was associated with better early clinical remission of AECOPD patients during hospitalisation. As stratified by ages, similar results were observed in elderly patients but not middle‐aged patients. Blood eosinophils at different ages may be valuable in personalised management for AECOPD.

Blood Eosinophils in Chinese COPD Participants and Response to Treatment with Combination Low-Dose Theophylline and Prednisone: A Post-Hoc Analysis of the TASCS Trial

“…Previous studies have reported some similarities, associating eosinophilia with elevated monocytes and lymphocytes, but also observing an inverse relationship with blood neutrophils. [20][21][22] Globally, analyses of the COPDgene, ECLIPSE, SPIROMICS datasets have found variable associations between these inflammatory cells and increased blood eosinophil counts in stable COPD participants -though male predisposition is evident in most studies. [23][24][25][26] While the mechanism for the observed treatment effect is unclear, it is possible that the study participants with eosinophilia defined by a blood eosinophil count ≥300 cells/µL display a hitherto unrecognized clinical phenotype.…”