scholarly journals Asthma-Like Features and Anti-Asthmatic Drug Prescription in Children with Non-CF Bronchiectasis

2020 ◽  
Vol 9 (12) ◽  
pp. 4009
Author(s):  
Konstantinos Douros ◽  
Olympia Sardeli ◽  
Spyridon Prountzos ◽  
Angeliki Galani ◽  
Dafni Moriki ◽  
...  
Keyword(s):  
Inhaled Corticosteroids ◽  
Drug Prescription ◽  
Ct Scans ◽  
Total Serum ◽  
Blood Eosinophil ◽  
Mosaic Pattern ◽  
Air Trapping ◽  
Serum Ige ◽  
Skin Prick Tests ◽  
Eosinophil Counts

Bronchiectasis and asthma may share some characteristics and some patients may have both conditions. The present study aimed to examine the rationale of prophylactic inhaled corticosteroids (ICS) prescription in children with bronchiectasis. Data of children with radiologically established bronchiectasis were retrospectively reviewed. Episodes of dyspnea and wheezing, spirometric indices, total serum IgE, blood eosinophil counts, sensitization to aeroallergens, and air-trapping on expiratory CT scans, were recorded. The study included 65 children 1.5–16 years old, with non-CF bronchiectasis. Episodes of dyspnea or wheezing were reported by 22 (33.8%) and 23 (35.4%), respectively. Skin prick tests to aeroallergens (SPTs) were positive in 15 (23.0%) patients. Mosaic pattern on CT scans was observed in 37 (56.9%) patients. Dyspnea, presence of mosaic pattern, positive reversibility test, and positive SPTs were significantly correlated with the prescription of ICS. The prescription of ICS in children with bronchiectasis is more likely when there are certain asthma-like characteristics. The difficulty to set the diagnosis of real asthma in cases of bronchiectasis may justify the decision of clinicians to start an empirical trial with ICS in certain cases.

scholarly journals Determinants of Bronchial Hyperresponsiveness in Subjects with Rhinitis

2005 ◽  
Vol 18 (4) ◽  
pp. 715-722 ◽  
Author(s):  
G. Di Lorenzo ◽  
ML. Pacor ◽  
P. Mansueto ◽  
M. Esposito Pellitteri ◽  
C. Lo Bianco ◽  
...  
Keyword(s):  
Nasal Obstruction ◽  
Geometric Mean ◽  
Bronchial Hyperresponsiveness ◽  
Total Serum ◽  
Blood Eosinophil ◽  
Serum Ige ◽  
Prick Test ◽  
Group A ◽  
Group B ◽  
Eosinophil Counts

Subjects with rhinitis but without asthma may have coexisting bronchial hyperresponsiveness, although the reasons for this are uncertain. To evaluate the factors that determine BHR in rhinitis we examined 410 patients with symptomatic rhinitis with forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) ≥ 80% of the predicted value. In all subjects a skin prick test (SPT) was performed, a determination of total serum IgE and an eosinophils count in the blood. Of the 410 subjects we found that 161 (39.3%) exhibited a methacholine PD20 of 800 mg or less (Group A), whereas 249 (60.7%) had a methacholine PD20 more of 800 mg (Group B). Despite the matched mean values for FEV1 and FVC, compared with Group B, Group A had a lower predicted forced expiratory flow between 25% and 75% (FEF25%-75%) (86.7 ± 12.0 vs. 93.7±7.3, P < 0.0001). A great portion of the subjects of the Group A in respect to subjects of the Group B were exposed to passive smoke (37.8% vs. 22.0%, P = 0.0008), reported having mothers with asthma (34.1% vs. 6.0%, P < 0.0001), presented a positive skin prick test (93.7% vs. 67.0%, P < 0.0001), had higher levels of total serum IgE (geometric mean of Log10 2.46 ± 0.27 kU/L vs. 2.06 ± 0.38 kU/L, P < 0.0001) and higher blood eosinophil counts (geometric mean of Log10 2.67 ± 0.07 × 10−3 mL vs. 2.57 ± 0.09 × 10−3 mL, P < 0.0001), and reported increased nasal obstruction (2.0 (95%CI 1.8 to 2.2) vs. 0.6 (95%CI 0.5 to 0.7), P < 0.0001). Logistic regression demonstrates that nasal obstruction (OR 2.19,95%CI 1.72 to 2.80) and the presence of positive SPT (OR 6.15,95%CI 2.42 to 15.61) were the most available predictors to discriminate between subjects with BHR and subjects without BHR. In addition, BHR was positively related to blood eosinophil counts (OR= 2.80, 95%CI 1.54 to 5.07), FEF25%-75% values (OR= 2.72, 95%CI 1.23 to 5.99) and familiarity (mother) for asthma (OR = 2.45, 95%CI 1.10 to 5.46). Whereas passive smoke and total serum IgE were not positively related to BHR. Increased nasal obstruction and the presence of positive SPT were the most available predictors to discriminate between subjects with and without BHR. Finally, BHR was positively related to blood eosinophil counts, FEF25%-75% values and to familiarity (mother) for asthma.

Absolute Blood Eosinophil Counts to Guide Inhaled Corticosteroids Therapy Among Patients with COPD: Systematic Review and Meta-analysis

2019 ◽  
Vol 20 (16) ◽  
pp. 1670-1679 ◽  
Author(s):  
Olorunfemi A. Oshagbemi ◽  
Jephthah O. Odiba ◽  
Abraham Daniel ◽  
Ismaeel Yunusa
Keyword(s):  
Systematic Review ◽  
Eosinophil Count ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Blood Eosinophil Count ◽  
Copd Patients ◽  
Phenotypic Group ◽  
Increased Risk ◽  
Eosinophil Counts

Introduction: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2019 recommends the use of absolute blood eosinophil count as a guide for the escalation and de-escalation of inhaled corticosteroids (ICS) in the pharmacological management of patients with chronic obstructive pulmonary disease (COPD). We evaluated the risk of moderate or severe exacerbations among patients escalating and de-escalating ICS therapy by absolute blood eosinophil thresholds in this systematic review. Methods: Through a comprehensive literature search of Pubmed/MEDLINE, EMBASE, and clinical trial sites up to April 2019, we identified relevant studies. We used generic inverse variance method with fixed-effects estimates to compare the risk of moderate or severe exacerbations among COPD patients with elevated blood eosinophil counts exposed to inhaled corticosteroids (ICS) versus non-ICS treatments groups expressed as risk ratios. Results: Ten studies (8 randomised control trials and 2 observational studies) were included, with a total of 85,059 COPD patients. In our pooled analysis, we found an overall reduction in risk of moderate or severe exacerbations in patients with absolute blood eosinophil thresholds ranging from ≥ 100 to ≥ 340 cells/µL among patients escalating ICS (RR, 0.77, 95% CI, 0.73-0.81). For studies evaluating the effects of de-escalation of ICS on moderate to severe exacerbations using blood eosinophil thresholds of ≥ 300 to ≥ 340 cells/µL had an increased risk of moderate or severe exacerbations following the de-escalation of ICS (RR, 1.66, 95% CI, 1.31-2.10). Conclusion: This study confirms the validity of the recommended absolute blood eosinophil count thresholds for the escalation and de-escalation of ICS among COPD patients. However, this recommendation is for COPD patients with prior exacerbations rather than among newly diagnosed COPD patients as observed in this study. COPD patients with current or past history of asthma represent a unique phenotypic group which should be further evaluated.

scholarly journals Blood eosinophil counts as markers of response to inhaled corticosteroids in COPD? – Authors' reply

2015 ◽  
Vol 3 (8) ◽  
pp. e27 ◽  
Author(s):  
Steven Pascoe ◽  
Nicholas Locantore ◽  
Mark T Dransfield ◽  
Neil C Barnes ◽  
Ian Pavord
Keyword(s):  
Inhaled Corticosteroids ◽  
Blood Eosinophil ◽  
Eosinophil Counts

scholarly journals Blood eosinophil count and risk of pneumonia hospitalisations in individuals with COPD

2018 ◽  
Vol 51 (5) ◽  
pp. 1800120 ◽  
Author(s):  
Signe Vedel-Krogh ◽  
Børge G. Nordestgaard ◽  
Peter Lange ◽  
Jørgen Vestbo ◽  
Sune F. Nielsen
Keyword(s):  
High Risk ◽  
General Population ◽  
Eosinophil Count ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Exacerbation Rate ◽  
General Population Study ◽  
Blood Eosinophil Count ◽  
Eosinophil Counts

Blood eosinophil count in chronic obstructive pulmonary disease (COPD) is associated with higher exacerbation rate and favourable response to corticosteroids; however, frequent exacerbations and use of inhaled corticosteroids could elevate pneumonia risk. We tested the hypothesis that high blood eosinophil counts are associated with high risk of pneumonia in individuals with severe COPD from the general population.We included 7180 individuals with COPD from the Copenhagen General Population Study, including 643 with forced expiratory volume in 1 s (FEV1) <50% predicted between 2003 and 2011. All primary discharge diagnoses of pneumonia during follow-up were recorded.Among individuals with COPD and FEV1<50% pred, the multivariable adjusted incidence rate ratio was 2.17 (95% CI 1.31–3.58) for pneumonia comparing individuals with blood eosinophil counts ≥0.34×109 cells·L−1versus<0.34×109 cells·L−1. In individuals with clinical COPD, defined by recent exacerbation, ≥10 pack-years of smoking and FEV1<70% pred, the corresponding risk was 4.52 (2.11–9.72). Risk of pneumonia did not differ by blood eosinophil count in individuals with COPD and FEV1≥50% pred.In individuals with COPD and FEV1<50% pred, blood eosinophil count ≥0.34×109 cells·L−1was associated with high risk of hospitalisation due to pneumonia.

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