Post-bronchodilator Reversibility of FEV 1 and Eosinophilic Airway Inflammation in COPD

Chou, Kun-Ta; Su, Kang‐Cheng; Hsiao, Yi-Han; Huang, Shiang Fen; Ko, Hsin-Kuo; Tseng, Ching-Min; Su, Vincent Yi-Fong; Perng, Diahn‐Warng

doi:10.1016/j.arbres.2017.01.014

Cited by 15 publications

(16 citation statements)

References 27 publications

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“…In a retrospective analysis, FEV 1 reversibility was weakly correlated with the sputum eosinophil level. Patients with FEV 1 >0.4 L and >15% increment had higher sputum eosinophil levels whereas the level did not differ when dichotomized by FEV 1 increment >0.2 L and >12% 19 . The response to corticosteroids in COPD patients were better in a subset of patients presenting with more eosinophils and higher levels of eosinophil cationic protein 20 , suggesting that corticosteroids may be effective especially for patients with COPD with eosinophilic airway inflammation 21 22 .…”

Section: Inflammation and Exacerbationmentioning

confidence: 76%

“…Zanini et al 92 reported that COPD patients with bronchial hyper-responsiveness (BHR) had higher sputum eosinophils than those without BHR. The change in FEV 1 was positively correlated with sputum eosinophils while patients had bronchial reversibility 19 92 . The prevalence of elevated serum IgE had been reported to be 47.3% in COPD patients 93 .…”

Section: How To Prevent Exacerbationmentioning

confidence: 91%

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The Relationship between Airway Inflammation and Exacerbation in Chronic Obstructive Pulmonary Disease

Perng

Chen

2017

Tuberc Respir Dis

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Chronic obstructive pulmonary disease (COPD) is associated with abnormal inflammatory response and airflow limitation. Acute exacerbation involves increased inflammatory burden leading to worsening respiratory symptoms, including dyspnea and sputum production. Some COPD patients have frequent exacerbations (two or more exacerbations per year). A substantial proportion of COPD patients may remain stable without exacerbation. Bacterial and viral infections are the most common causative factors that breach airway stability and lead to exacerbation. The increasing prevalence of exacerbation is associated with deteriorating lung function, hospitalization, and risk of death. In this review, we summarize the mechanisms of airway inflammation in COPD and discuss how bacterial or viral infection, temperature, air pollution, eosinophilic inflammation, and concomitant chronic diseases increase airway inflammation and the risk of exacerbation.

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Section: Inflammation and Exacerbationmentioning

confidence: 76%

Section: How To Prevent Exacerbationmentioning

confidence: 91%

The Relationship between Airway Inflammation and Exacerbation in Chronic Obstructive Pulmonary Disease

Perng

Chen

2017

Tuberc Respir Dis

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“…As early as 2006, scholars discovered EOS in 20%–40% of induced sputum specimens and large and small airway tissues of patients with stable COPD, and the increase in EOS in the airway was related to acute exacerbation. 9 The pathogenesis of COPD is heterogeneous and complex in terms of inflammation. In order to further explore the occurrence and development of COPD, it is of great clinical value to identify biomarkers that can be used to guide treatment, evaluate the condition, and predict prognosis.…”

Section: Discussionmentioning

confidence: 99%

Clinical value of IL-13 and ECP in the serum and sputum of eosinophilic AECOPD patients

Gao

et al. 2020

Exp Biol Med (Maywood)

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Chronic obstructive pulmonary disease (COPD) is a heterogeneous inflammatory disease and eosinophils (EOS) participate in inflammation process. Acute exacerbation of COPD (AECOPD) is an inevitable trend in the development of the disease and has attracted widespread attention. In the present study, 108 hospitalized patients with AECOPD were collected and the levels of interleukin-13 and eosinophil cationic protein in the serum and sputum were measured to explore their clinical value in eosinophilic AECOPD patients. The patients were divided into an eosinophilic group (52 cases, 48.15%) and a noneosinophilic group (56 cases, 51.85%). The eosinophilic group had fewer acute exacerbations in the past year, shorter average hospitalization days, lower respiratory failure rate, mechanical ventilation utilization rate, and lower CAT and mMRC scores ( P < 0.05). The levels of interleukin-13 and eosinophil cationic protein in sputum in the eosinophilic group were higher than those in the noneosinophilic group ( P < 0.05), and there was no significant difference in the serum between the two groups ( P > 0.05). The receiver operating characteristic (ROC) curves of sputum interleukin-13 and eosinophil cationic protein predicting peripheral blood EOS% ≥2% of AECOPD patients were statistically significant ( P < 0.05). The noneosinophilic group had a higher rate of rehospitalization due to acute exacerbation during the one-year follow-up, and there was no significant difference in mortality between the two groups. The results show that eosinophils in peripheral blood are a simple, convenient, and inexpensive index for assessing the condition and prognosis of AECOPD patients. Interleukin-13 and eosinophil cationic protein are involved in the pathogenesis of eosinophilic AECOPD and may be the new targeted anti-inflammatory therapies in the future. Impact statement Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is an inevitable trend in the development of the disease and eosinophils (EOS) participate in inflammation process. It is important to explore some relatively simple biomarkers in AECOPD which are useful to recognize the disease. In the present study, 108 hospitalized patients with AECOPD were collected and the levels of IL-13 and ECP in the serum and sputum were measured. The levels of IL-13 and ECP in sputum in the eosinophilic group were higher than those in the noneosinophilic group. Moreover, the noneosinophilic group had a higher rate of rehospitalization due to acute exacerbation during the one-year follow-up. The results show that eosinophils in peripheral blood are a simple, convenient, and inexpensive index for assessing the condition and prognosis of AECOPD patients. IL-13 and ECP are involved in the pathogenesis of eosinophilic AECOPD and may be the new targeted anti-inflammatory therapies.

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“…Second, the accuracy of the blood eosinophil population as a surrogate marker of the corresponding airway population remains a challenge. Although some studies suggested a relationship, further data analysis revealed a weak correlation and a poor diagnostic profile …”

Section: Step Up From Double Bronchodilation To Triple Therapymentioning

confidence: 94%

“…Several biomarkers have been associated with ACO, including a positive bronchodilator test, bronchial hyper‐responsiveness or peripheral blood or sputum eosinophilia. Although several observational studies have indicated interrelationships among these biomarkers at the cohort level, multiple studies have indicated mismatches among these biomarkers at the patient level . Consequently, the biomarkers needed to identify this specific population remain unknown.…”

Section: Step Up From Double Bronchodilation To Triple Therapymentioning

confidence: 99%

Current controversies in the stepping up and stepping down of inhaled therapies for COPD at the patient level

et al. 2018

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The implementation of potential new step-up or step-down treatment recommendations in response to current guidelines is one of the main challenges currently faced in actual daily practice settings. In the present narrative review, we aim to discuss the relevance of these step-up and step-down proposals at the patient level in daily clinical practice. In particular, we aim to review the challenges associated with inhaled maintenance therapy for chronic obstructive pulmonary disease (COPD) in four clinical scenarios. First, we discuss the step up from single to double bronchodilation, including current controversies regarding the addition of a second bronchodilator versus initial treatment with two bronchodilators. Second, we discuss the step up from double bronchodilation to triple therapy while challenging current indications for inhaled steroid therapy and discussing triple therapy designs. Third, we discuss the step down from triple therapy to double bronchodilation while evaluating the effect of this downshift in risk categories on the patient according to the new classifications. Finally, we discuss the step down from double to single bronchodilation, with a special focus on safety. We believe this review will help to highlight the most relevant discussion points regarding the treatment of COPD in a manner that will stimulate and guide related clinical research.

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Post-bronchodilator Reversibility of FEV 1 and Eosinophilic Airway Inflammation in COPD

Cited by 15 publications

References 27 publications

The Relationship between Airway Inflammation and Exacerbation in Chronic Obstructive Pulmonary Disease

The Relationship between Airway Inflammation and Exacerbation in Chronic Obstructive Pulmonary Disease

Clinical value of IL-13 and ECP in the serum and sputum of eosinophilic AECOPD patients

Current controversies in the stepping up and stepping down of inhaled therapies for COPD at the patient level

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