Using Blood Eosinophil Count as a Biomarker to Guide Corticosteroid Treatment for Chronic Obstructive Pulmonary Disease

Sivapalan, Pradeesh; Bikov, András

doi:10.3390/diagnostics11020236

Cited by 13 publications

(5 citation statements)

References 97 publications

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“…The former category of patients tends to exhibit a lower risk profile with a shorter length of hospitalization, reduced morbidity, and a better response to corticosteroid treatment [ 49 ]. In contrast, high YKL-40 individuals may benefit more from treatment with antibiotics instead of systemic corticosteroids [ 50 ], as low eosinophils are associated with a higher prevalence of bacterial exacerbations [ 49 ]. One may hence expect a more severe impairment in the immune response of these patients that is potentially related to immune cell exhaustion and leads to a more severe risk profile and clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Serum YKL-40 Levels, Leukocyte Profiles, and Acute Exacerbations of Advanced COPD

Popețiu,

Donath-Miklos,

Borta

et al. 2023

JCM

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Little information exists on YKL-40—a key protein in tissue remodeling—and complete blood count (CBC) parameters during acute exacerbations of advanced chronic obstructive pulmonary disease (COPD). This pilot exploratory study (August 2020–January 2021) investigated the connection between serum YKL-40 levels and CBC profile in sex- and age-matched individuals with severe COPD (GOLD stage III, n = 23, median age = 66 years, 65.21% males) and very severe COPD (GOLD stage IV, n = 24, median age = 66.5 years, 74.81% males). The measured parameters were serum YKL-40, absolute leukocyte count (ALLC), absolute neutrophil count (ANC), neutrophil percentage, absolute lymphocyte count (ALC), lymphocyte percentage, neutrophil-to-lymphocyte ratio (NLR), absolute eosinophil count (AEC), eosinophil percentage, absolute monocyte count (AMC), monocyte percentage, absolute basophil count (ABC), basophil percentage, hemoglobin levels, and hematocrit concentrations. No significant inter-group differences were observed. However, high YKL-40 subjects (n = 23)—as stratified via median YKL-40 (3934.5 pg/mL)—showed significantly increased neutrophil percentage and NLR but significantly lower lymphocyte-, eosinophil-, and basophil-related parameters compared to low YKL-40 patients (n = 24). These results reveal multidimensional, YKL-40-associated changes in leukocyte profile of patients with advanced COPD during acute exacerbations, with potential implications for personalized treatment.

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Section: Discussionmentioning

confidence: 99%

Serum YKL-40 Levels, Leukocyte Profiles, and Acute Exacerbations of Advanced COPD

Popețiu,

Donath-Miklos,

Borta

et al. 2023

JCM

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“…However, because all the patients were prospectively enrolled in the national COPD care program of Taiwan, most data pertaining to the relevant events and other medical details can be traced on the e-cloud system of National Health Insurance in Taiwan. Finally, without randomization and blindness, the present study may include confounding factors, such as the implementation of pulmonary rehabilitation ( Weiner and Weiner, 2006 ), which may affect the inspiratory flow rate; the change of therapeutic strategies or regimens with disease status or with updated guidelines such as serum biomarker directed inhaled corticosteroid treatment ( Sivapalan et al, 2021 ), better treatment of comorbidities by multidiscipline members, which may all affect the outcome of acute exacerbation. In the future, further research involving prospectively randomized control study is necessary to overcome these limitations.…”

Section: Discussionmentioning

confidence: 99%

Peak-Inspiratory-Flow-Rate Guided Inhalation Therapy Reduce Severe Exacerbation of COPD

et al. 2021

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Optimal peak inspiratory flow rate (PIFR) is crucial for inhalation therapy in patients with chronic obstructive pulmonary disease (COPD). However, little is known about the impact of PIFR-guided inhalation therapy on the clinical outcomes among patients with varying severities of COPD. A PIFR-guided inhalation therapy, including PIFR assessment and PIFR-guided inhaler education, was introduced in a pay-for-performance COPD management program in National Taiwan University Hospital. Among 383 COPD patients, there was significant reduction in incidence of severe acute exacerbation in the PIFR-guided inhalation therapy (PIFR group) than conventional inhaler education (control group) (11.9 vs. 21.1%, p = 0.019) during one-year follow-up. A multivariable Cox’s proportional-hazards analysis revealed that the PIFR-guided inhalation therapy was a significant, independent factor associated with the reduced risk of severe exacerbation (adjusted hazard ratio = 0.49, 95% confidence interval, 0.28–0.84, p = 0.011). Subgroup analysis found PIFR-guided inhalation therapy was more beneficial to patients with older age, short body stature, COPD stage 1&2, group C&D (frequent exacerbation phenotype), and using multiple inhalers. This study showed the PIFR-guided inhalation therapy significantly reduced the incidence of severe acute exacerbation than conventional inhaler education in patients with COPD. Careful PIFR-assessment and education would be crucial in the management of COPD.

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“…Measuring blood eosinophils has clinical potential for tailoring systemic corticosteroid treatment for COPD acute exacerbations [ 14 ]. Previous trials have shown that eosinophil-guided systemic corticosteroid treatment for acute exacerbation of COPD was non-inferior to standard of care [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Blood eosinophils are surrogate markers for predicting the response to steroid treatment in patients with COPD [ 14 ]. The CORTICO-COP trial investigated a biomarker-guided approach to corticosteroid treatment based on daily blood eosinophil count [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Corticosteroid Resistance in Smokers—A Substudy Analysis of the CORTICO-COP Randomised Controlled Trial

Sivapalan

Bikov

Ulrik

et al. 2021

JCM

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The CORTICO-COP trial showed that eosinophil-guided corticosteroid-sparing treatment for acute exacerbation of chronic obstructive pulmonary disease was non-inferior to standard of care and decreased the accumulated dose of systemic corticosteroids that patients were exposed to by approximately 60%. Smoking status has been shown to affect corticosteroid responsiveness. This post hoc analysis investigated whether eosinophil-guided treatment is non-inferior to conventional treatment in current smokers. The main analysis of current smokers showed no significant difference in the primary endpoint, days alive, and out of hospital within 14 days between the control group (mean, 9.8 days; 95% confidence interval (CI), 8.7–10.8) and the eosinophil-guided group (mean, 8.7 days; 95% CI, 7.5–9.9; p = 0.34). Secondary analyses of the number of exacerbations or deaths, the number of intensive care unit admissions or deaths, lung function improvement, and change in health-related quality of life also showed no significant differences between the two groups. The results of a sensitivity analysis of ex-smokers are consistent with the main analysis. Our results suggest that eosinophil-guided treatment is non-inferior to standard of care in current smokers and ex-smokers. Because data on the impact of smoking status on eosinophil-guided treatments are sparse, more randomised trials are needed to confirm our results.

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Using Blood Eosinophil Count as a Biomarker to Guide Corticosteroid Treatment for Chronic Obstructive Pulmonary Disease

Cited by 13 publications

References 97 publications

Serum YKL-40 Levels, Leukocyte Profiles, and Acute Exacerbations of Advanced COPD

Serum YKL-40 Levels, Leukocyte Profiles, and Acute Exacerbations of Advanced COPD

Peak-Inspiratory-Flow-Rate Guided Inhalation Therapy Reduce Severe Exacerbation of COPD

Corticosteroid Resistance in Smokers—A Substudy Analysis of the CORTICO-COP Randomised Controlled Trial

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