Blood Eosinophil Counts in Chronic Obstructive Pulmonary Disease: A Biomarker of Inhaled Corticosteroid Effects

Treating patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease (COPD) usually involves administering systemic corticosteroids. The many unwanted side effects associated with this treatment have led to increased interest in minimising the accumulated corticosteroid dose necessary to treat exacerbations. Studies have shown that short-term treatment with corticosteroids is preferred, and recent trials have shown that biomarkers can be used to further reduce exposure to corticosteroids. Interestingly, high eosinophil counts in patients with acute exacerbations of COPD are indicative of an eosinophilic phenotype with a distinct response to treatment with corticosteroids. In addition, post-hoc analysis of randomised control trials have shown that higher blood eosinophil counts at the start of the study predict a greater response to inhaled corticosteroids in stable COPD. In this review, we examine the studies on this topic, describe how blood eosinophil cell count may be used as a biomarker to guide treatment with corticosteroids, and identify some relevant challenges.

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Correlation between FEV1% Predicted and Blood Eosinophils in Patients with Exacerbations of Chronic Obstructive Pulmonary Disease (COPD)

Jurnal Respirasi ◽

10.20473/jr.v7-i.2.2021.59-64 ◽

2021 ◽

Vol 7 (2) ◽

pp. 59

Author(s):

Alfian Nurfaizi ◽

Isnin Anang Marhana ◽

Gadis Meinar Sari ◽

Arief Bakhtiar

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Chronic Obstructive ◽

Blood Eosinophil ◽

Normal Body Mass Index ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

Copd Exacerbations ◽

Blood Eosinophils ◽

Eosinophil Counts

Introduction: Chronic obstructive pulmonary disease (COPD) exacerbations are still the leading causes of mortality. Eosinophil counts were recommended in assessing the risk of exacerbations. This additional examination was preferred rather than the pulmonary function test (PFT), which was considered less precise and had vast differences. Therefore, an analysis of the correlation between the FEV1% predicted and blood eosinophil counts were needed as a reference in the diagnosis of COPD exacerbation. This study aimed to determine the correlation between FEV1% predicted and blood eosinophils counts in patients with COPD exacerbations.Methods: This was a retrospective cross-sectional study by analyzing medical records of patients with COPD exacerbations at Dr. Soetomo General Hospital, Surabaya, from 2017 to 2018.Results: The characteristics of patients with exacerbations of COPD consisted of 91.7% male patients. Most of them were in the age group of 61-70 years old, 58.3% were in the private sector, 75% had a high school diploma, and 41.7% had normal body mass index (BMI). The percentage of the FEV1% predicted is directly proportional to the percentage of blood eosinophils with weak and statistically insignificant strength.Conclusion: The FEV1% predicted and blood eosinophil counts had a very weak correlation and statistically insignificant strength. Thus, it could not be used as a reference for diagnosis using one of the variables. Further research is needed with sputum eosinophils and biopsy as consideration for more accurate results.

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Narrative Literature Review Guided Approach of Inhaled Corticosteroid de-escalation in Chronic Obstructive Pulmonary Disease

Journal of Pharmacy Practice ◽

10.1177/08971900211053771 ◽

2021 ◽

pp. 089719002110537

Author(s):

Anamarie Tomaich ◽

Shawnee Klatt ◽

Michael W. Nagy

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Inhaled Corticosteroids ◽

Chronic Obstructive Lung Disease ◽

Chronic Obstructive ◽

Blood Eosinophil ◽

Inhaled Corticosteroid ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Long Acting

Objective To review the 2020 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report recommendations and create an algorithm to assist clinicians in determining which chronic obstructive pulmonary disease (COPD) patients qualify for inhaled corticosteroid (ICS) de-escalation. Data Sources: A literature search of MEDLINE/PubMed from 2002 to August 2021 was conducted using the search terms inhaled corticosteroids, chronic obstructive pulmonary disease, and de-escalation and review of the reference lists of identified articles for pertinent citations. Study Selection and Data Extraction Relevant studies and articles were included if they focused on the utilization of ICS in COPD. Data Synthesis The 2020 GOLD report only recommends triple therapy with ICS, long acting beta agonists, and long acting muscarinic antagonists for patients with frequent exacerbations, frequent hospitalizations, or elevated blood eosinophil counts. Despite this clear framework, patients are prescribed ICS without these characteristics. Available evidence suggests that these patients can be de-escalated from ICS therapy without concern for worsening lung function or exacerbations. Relevance to Patient Care and Clinical Practice: Patients with COPD may be experiencing more risk than benefit on ICS therapy. Clinicians should be knowledgeable on how to evaluate patient therapy for appropriateness and know how to safely deprescribe ICS given their limited efficacy in many COPD patients. Conclusion There remains no specific guidance on how to de-escalate patients off an ICS when the therapy is not indicated. Use of clinical evidence with stepwise algorithms can be models to approach de-escalation of ICS in patients with COPD.

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Pulmonary inflammation in patients with chronic obstructive pulmonary disease with higher blood eosinophil counts

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2017.04.027 ◽

2017 ◽

Vol 140 (4) ◽

pp. 1181-1184.e7 ◽

Cited By ~ 34

Author(s):

Umme Kolsum ◽

Gautam Damera ◽

Tuyet-Hang Pham ◽

Thomas Southworth ◽

Sarah Mason ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Pulmonary Inflammation ◽

Chronic Obstructive ◽

Blood Eosinophil ◽

Obstructive Pulmonary Disease ◽

Eosinophil Counts

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Blood eosinophil count-guided corticosteroid therapy and as a prognostic biomarker of exacerbations of chronic obstructive pulmonary disease: a systematic review and meta-analysis

Therapeutic Advances in Chronic Disease ◽

10.1177/20406223211028768 ◽

2021 ◽

Vol 12 ◽

pp. 204062232110287

Author(s):

Tao Liu ◽

Zi-Jian Xiang ◽

Xiao-Meng Hou ◽

Jing-Jing Chai ◽

Yan-Li Yang ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Prognostic Biomarker ◽

Meta Analysis ◽

Cochrane Library ◽

Chronic Obstructive ◽

Blood Eosinophil ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

The Stability

Background: Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and dyspnea, as well as an increase in the number of leukocytes in the airways, lungs, and pulmonary vessels. A ‘One size fits all’ approach to COPD patients with different clinical features may be considered outdated. The following are the two major objectives of this meta-analysis: the first is to determine if blood eosinophil counts (BEC) can serve as a prognostic biomarker of COPD outcomes, and the second is to determine which level of BEC is effective for inhaled corticosteroid (ICS) treatment. Methods: We searched articles published before 15 May 2021 in the following four electronic databases: Web of Science, Cochrane Library, EMBASE, and PubMed. Results: A total of 42 studies, comprising a sampling of 188,710 subjects, were summarized and compared in this meta-analysis. The rate ratio (RR) of exacerbations of COPD (ECOPD) between ICS and non-ICS treatment was statistically significant for the COPD patients with a baseline BEC ⩾ 2% or ⩾ 200 cells/μl, RR = 0.82 (0.73, 0.93) or 0.79 (0.70, 0.89) respectively, while the RR of ECOPD between ICS and non-ICS treatment was statistically insignificant for the COPD patients with baseline BEC < 2% or <200 cells/μl, RR = 0.97 (0.87, 1.08) or 0.97 (0.86, 1.08), suggested that ICS therapy was beneficial to the improvement of ECOPD in patients with a baseline BEC ⩾ 2% or BEC ⩾ 200 cells/μl. Conclusion: Our research shows that a BEC ⩾ 200 cells/μl or ⩾2% is likely to become the cutoff value of ICS treatment for ECOPD. Moreover, we believe that the baseline BEC can be used as a biomarker for predicting ECOPD. The stability of BEC requires special attention.

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