Response to corticosteroids in chronic bronchitis

Cs, Shim; Stover, Diane E.; Williams, M. Henry

doi:10.1016/0091-6749(78)90137-9

Cited by 86 publications

(38 citation statements)

References 12 publications

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“…Although primarily associated with asthma, eosinophilic airway inflammation is present in some patients with COPD (8). Previous studies have shown that a sputum eosinophilia is associated with a positive response to corticosteroid treatment in stable COPD (9)(10)(11), and the sputum eosinophil count can be used to titrate corticosteroid therapy to reduce exacerbations of COPD (12).…”

mentioning

confidence: 99%

Blood Eosinophils to Direct Corticosteroid Treatment of Exacerbations of Chronic Obstructive Pulmonary Disease

Bafadhel

McKenna

Terry

et al. 2012

Am J Respir Crit Care Med

539

455

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Rationale: Exacerbations of chronic obstructive pulmonary disease (COPD) and responses to treatment are heterogeneous. Objectives: Investigate the usefulness of blood eosinophils to direct corticosteroid therapy during exacerbations. Methods: Subjects with COPD exacerbations were entered into a randomized biomarker-directed double-blind corticosteroid versus standard therapy study. Subjects in the standard arm received prednisolone for 2 weeks, whereas in the biomarker-directed arm, prednisolone or matching placebo was given according to the blood eosinophil count biomarker. Both study groups received antibiotics. Blood eosinophils were measured in the biomarker-directed and standard therapy arms to define biomarker-positive and -negative exacerbations (blood eosinophil count . and < 2%, respectively). The primary outcome was to determine noninferiority in health status using the chronic respiratory questionnaire (CRQ) and in the proportion of exacerbations associated with a treatment failure between subjects allocated to the biomarker-directed and standard therapy arms. Measurements and Main Results: There were 86 and 80 exacerbations in the biomarker-directed and standard treatment groups, respectively. In the biomarker-directed group, 49% of the exacerbations were not treated with prednisolone. CRQ improvement after treatment in the standard and biomarker-directed therapy groups was similar (0.8 vs. 1.1; mean difference, 0.3; 95% confidence interval, 0.0-0.6; P ¼ 0.05). There was a greater improvement in CRQ in biomarker-negative exacerbations given placebo compared with those given prednisolone (mean difference, 0.45; 95% confidence interval, 0.01-0.90; P ¼ 0.04). In biomarker-negative exacerbations, treatment failures occurred in 15% given prednisolone and 2% of those given placebo (P ¼ 0.04). Conclusions: The peripheral blood eosinophil count is a promising biomarker to direct corticosteroid therapy during COPD exacerbations, but larger studies are required. Clinical trial registered with www.controlled-trials.com (ISRCTN 92422949).Keywords: chronic obstructive pulmonary disease; exacerbations; prednisolone; infection; eosinophils Acute exacerbations of chronic obstructive pulmonary disease (COPD) are associated with substantial morbidity and mortality (1, 2) and are heterogeneous with respect to inflammation (3, 4) and etiology (5-7). Although primarily associated with asthma, eosinophilic airway inflammation is present in some patients with COPD (8). Previous studies have shown that a sputum eosinophilia is associated with a positive response to corticosteroid treatment in stable COPD (9-11), and the sputum eosinophil count can be used to titrate corticosteroid therapy to reduce exacerbations of COPD (12).Current guidelines advocate the use of systemic corticosteroids during acute exacerbations of COPD because of improvements in the rate of recovery (13,14); this is despite being associated with significant side effects (15) and with limited benefits in reducing mortality (14). Increased eosinophilic air...

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confidence: 99%

Blood Eosinophils to Direct Corticosteroid Treatment of Exacerbations of Chronic Obstructive Pulmonary Disease

Bafadhel

McKenna

Terry

et al. 2012

Am J Respir Crit Care Med

539

455

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“…In addition, our studies suggest that only 20-25% of stable COPD patients will respond to inhaled steroids, but the rate of response is about 75% when inhaled steroids are administered to patients whose airway resistance is significantly decreased following ␤ 2 -agonist inhalation. In several studies [5,7], corticosteroid responders also showed a response to inhaled bronchodilators. However, certain others [9,11] have shown a failure of ␤ 2 -agonist reversibility to predict steroid response.…”

Section: Discussionmentioning

confidence: 99%

“…However, previous studies performed by us [3] and by others [4][5][6][7] have shown, with objective measurements of improved airflow, rates of response to corticosteroids of about 25% in stable COPD patients. Because of the serious adverse effect of a long course of oral corticosteroid treatment, inhaled steroids became attractive as a means of treatment in asthma [8], and more recently also in patients with COPD [9][10][11][12].…”

Section: Introductionmentioning

confidence: 95%

The response to inhaled and oral steroids in patients with stable chronic obstructive pulmonary disease

Weiner

Rabner

et al. 1999

Journal of Internal Medicine

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“…For example, BROWN [3] and SHIM et al [4] have observed that sputum eosinophilia predicts a good response to treatment with prednisolone in patients with chronic airflow limitation associated with chronic asthma and chronic bronchitis, respectively. This observation is supported in recent reports using improved methods of sputum examination [5,10].…”

Section: Discussionmentioning

confidence: 99%

“…Its pathogenesis is considered to include an eosinophilic airway inflammatory process [1,2]. Eosinophilic airway inflammation with reversible airflow limitation are usually steroid responsive [3][4][5]. However, chronic airflow limitation can also result from inflammatory processes distinct from those of asthma, e.g.…”

mentioning

confidence: 99%

Serial sputum cell counts in the management of chronic airflow limitation

Parameswaran

Pizzichini²,

Li³

et al. 1998

Eur Respir J

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This case study illustrates the usefulness of serial induced sputum cell counts from cytospins to investigate the nature of airway inflammation in a patient presumed to have prednisone-dependent asthma for 30 yrs. She had bronchiectasis and chronic airflow limitation. Exacerbations of breathlessness were associated with an increase in chronic airflow limitation with little or no sputum. Induced sputum showed elevated total cell and neutrophil counts at each exacerbation with no increase in the proportion of eosinophils. Pathogenic bacteria were cultured at each flare-up. The dose of prednisone was reduced progressively and each exacerbation was treated with an appropriate antibiotic without increasing the dose of prednisone, as was the case previously. The infections were associated with bronchiectasis of the right upper lobe which was removed. Examination of the specimen confirmed neutrophilic infiltration and did not show the usual airway structural changes of asthma. These results provide further evidence of the value of sputum cell counts in practice, in this case to prevent overtreatment with prednisone in a patient with recurrent deteriorations in airflow which were due to recurrent infections.

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Response to corticosteroids in chronic bronchitis

Cited by 86 publications

References 12 publications

Blood Eosinophils to Direct Corticosteroid Treatment of Exacerbations of Chronic Obstructive Pulmonary Disease

Blood Eosinophils to Direct Corticosteroid Treatment of Exacerbations of Chronic Obstructive Pulmonary Disease

The response to inhaled and oral steroids in patients with stable chronic obstructive pulmonary disease

Serial sputum cell counts in the management of chronic airflow limitation

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