Prognostic and Predictive Value of Blood Eosinophil Count, Fractional Exhaled Nitric Oxide, and Their Combination in Severe Asthma: A Post Hoc Analysis

Objective: This study aimed to explore the usefulness of the peripheral blood eosinophil count (PBEC) in assessing the level of fractional exhaled nitric oxide (FeNO) and predicting bronchodilation test results. Methods: We retrospectively analyzed the data of 384 outpatients who underwent FeNO measurement at our Department of Respiratory and Critical Care Medicine from March to June 2019. The FeNO level was compared among different PBECs to explore the association among them. Furthermore, the sensitivity and specificity of PBECs in predicting bronchodilation test results were assessed by using receiver operating characteristic (ROC) curve analysis. Results: There was a moderate correlation between PBECs and FeNO levels (r = 0.414; p < 0.05). In the subjects with PBECs ≥ 0.3 × 109/L, the median FeNO level was 39 ppb (interquartile range, 22.5‐65.5 ppb), significantly higher than in the subjects with PBECs < 0.3 × 109/L. The area under the ROC curve was 0.707 (p < 0.05). The maximum Youden index (0.348) was at PBECs = 0.205 × 109/L, which achieved sensitivity and specificity of 63% and 71.8%, respectively. Conclusion: PBECs ≥ 0.3 × 109/L can predict a positive bronchodilation test result and a high FeNO level, with a probability of 50% in the subjects with chronic cough and shortness of breath; in the absence of corresponding symptoms and a low PBEC, the predictive value was small. For hospitals not able to conduct FeNO measurements, for outpatients with poor economic conditions, and for patients with confirmed or suspected novel coronavirus disease 2019, the PBEC, in conjunction with a patient's clinical symptoms, can improve the diagnostic accuracy of allergic asthma and assessment of airway inflammation while reducing the risk of infection.

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P13 Exhaled nitric oxide and blood eosinophil count in predicting sputum inflammatory type in a heterogeneous airways disease population

10.1136/thorax-2019-btsabstracts2019.156 ◽

2019 ◽

Author(s):

L Lehtimäki ◽

R Shrimanker ◽

A Moran ◽

G Hynes ◽

S Thulborn ◽

...

Keyword(s):

Nitric Oxide ◽

Eosinophil Count ◽

Exhaled Nitric Oxide ◽

Blood Eosinophil ◽

Blood Eosinophil Count

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Fractional Exhaled Nitric Oxide and Peripheral Blood Eosinophil Count Prognostic and Predictive Biomarkers in Severe Eosinophilic Asthma

10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a1296 ◽

2019 ◽

Author(s):

R. Shrimanker ◽

R. Price ◽

S.E. Wenzel ◽

S. Yancey ◽

I. Pavord

Keyword(s):

Nitric Oxide ◽

Peripheral Blood ◽

Eosinophil Count ◽

Predictive Biomarkers ◽

Blood Eosinophil ◽

Fractional Exhaled Nitric Oxide ◽

Eosinophilic Asthma ◽

Peripheral Blood Eosinophil ◽

Blood Eosinophil Count ◽

Severe Eosinophilic Asthma

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Treatment failure and hospital readmissions in severe COPD exacerbations treated with azithromycin versus placebo – a post-hoc analysis of the BACE randomized controlled trial

Respiratory Research ◽

10.1186/s12931-019-1208-6 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Kristina Vermeersch ◽

◽

Ann Belmans ◽

Kris Bogaerts ◽

Iwein Gyselinck ◽

...

Keyword(s):

Treatment Failure ◽

Incidence Rate ◽

Eosinophil Count ◽

Hospital Readmissions ◽

Smoking History ◽

Blood Eosinophil ◽

Copd Exacerbation ◽

Blood Eosinophil Count ◽

Post Hoc Analysis ◽

Post Hoc

Abstract Background In the BACE trial, a 3-month (3 m) intervention with azithromycin, initiated at the onset of an infectious COPD exacerbation requiring hospitalization, decreased the rate of a first treatment failure (TF); the composite of treatment intensification (TI), step-up in hospital care (SH) and mortality. Objectives (1) To investigate the intervention’s effect on recurrent events, and (2) to identify clinical subgroups most likely to benefit, determined from the incidence rate of TF and hospital readmissions. Methods Enrolment criteria included the diagnosis of COPD, a smoking history of ≥10 pack-years and ≥ 1 exacerbation in the previous year. Rate ratio (RR) calculations, subgroup analyses and modelling of continuous variables using splines were based on a Poisson regression model, adjusted for exposure time. Results Azithromycin significantly reduced TF by 24% within 3 m (RR = 0.76, 95%CI:0.59;0.97, p = 0.031) through a 50% reduction in SH (RR = 0.50, 95%CI:0.30;0.81, p = 0.006), which comprised of a 53% reduction in hospital readmissions (RR = 0.47, 95%CI:0.27;0.80; p = 0.007). A significant interaction between the intervention, CRP and blood eosinophil count at hospital admission was found, with azithromycin significantly reducing hospital readmissions in patients with high CRP (> 50 mg/L, RR = 0.18, 95%CI:0.05;0.60, p = 0.005), or low blood eosinophil count (<300cells/μL, RR = 0.33, 95%CI:0.17;0.64, p = 0.001). No differences were observed in treatment response by age, FEV1, CRP or blood eosinophil count in continuous analyses. Conclusions This post-hoc analysis of the BACE trial shows that azithromycin initiated at the onset of an infectious COPD exacerbation requiring hospitalization reduces the incidence rate of TF within 3 m by preventing hospital readmissions. In patients with high CRP or low blood eosinophil count at admission this treatment effect was more pronounced, suggesting a potential role for these biomarkers in guiding azithromycin therapy. Trial registration ClinicalTrials.gov number. NCT02135354.

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