Blood eosinophil count variability in chronic obstructive pulmonary disease and severe asthma

Abe, Yuki; Suzuki, Masaru; Kimura, Hirokazu; Shimizu, Kaoruko; Takei, Nozomu; Oguma, Akira; Matsumoto-Sasaki, Machiko; Goudarzi, Houman; Makita, Hironi; Nishimura, Masaharu; Konno, Satoshi

doi:10.1016/j.alit.2022.11.012

Cited by 10 publications

(3 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Whether airway eosinophil infiltration is higher in smokers with COPD than in those without COPD remains unestablished [11,26,27]. Studies have demonstrated that eosinophilic inflammation is heterogeneous among patients with COPD [1,28]. It is possible that eosinophilic inflammation in peripheral airways is a feature in subgroups of smokers, especially without COPD and/or with mild COPD.…”

Section: Discussionmentioning

confidence: 99%

Association between blood eosinophil count and small airway eosinophils in smokers with and without COPD

et al. 2023

View full text Add to dashboard Cite

IntroductionAirway eosinophilic inflammation is a pathological feature in a subgroup of patients with chronic obstructive pulmonary disease (COPD) and in some smokers with a high COPD risk. Although blood eosinophil count is used to define eosinophilic COPD, the association between blood eosinophil count and airway eosinophilic inflammation remains controversial. This cross-sectional study tested this association in smokers with and without COPD while considering potential confounders, such as smoking status and comorbidities.MethodsLung specimens were obtained from smokers with and without COPD and non-COPD never smokers undergoing lung lobectomy. Those with any asthma history were excluded. The infiltration of eosinophils into the small airway wall was quantified on histological sections stained with major basic protein (MBP).ResultsThe number of airway MBP-positive cells was greater in smokers (n=60) than in never smokers (n=14). Smokers with and without COPD (n=30 /each) exhibited significant associations between blood eosinophil count and airway MBP-positive cells (ρ= 0.45 and 0.71). When smokers were divided into the high and low airway MBP groups based on their median value, blood eosinophil count was higher in the high MBP group, with no difference in age, smoking status, comorbidities, emphysema or coronary artery calcification on computed tomography, and inhaled corticosteroid (ICS) use. The association between greater blood eosinophil count and the high MBP group was confirmed in multivariable models adjusted for smoking status, airflow limitation, and ICS use.ConclusionThe blood eosinophil count may reflect eosinophilic inflammation in the small airways in smokers with and without COPD.

show abstract

Section: Discussionmentioning

confidence: 99%

Association between blood eosinophil count and small airway eosinophils in smokers with and without COPD

et al. 2023

View full text Add to dashboard Cite

show abstract

“…27 Regarding COPD variability, among patients with COPD, the number of asthma-like features (bronchodilator reversibility, blood eosinophilia, and atopy) affects the blood eosinophil count variation patterns. 28 The variability of baseline eosinophil count has been reported in the literature, and there were attempts to categorize into various risk groups based on blood eosinophil count. Using a single cut-off of baseline eosinophil count may have the problem of misclassifying a patient into an inappropriate risk group, as well as affecting the choice of ICS use.…”

Section: Discussionmentioning

confidence: 99%

Variability of Blood Eosinophil Count at Stable-State in Predicting Exacerbation Risk of Chronic Obstructive Pulmonary Disease

Kwok¹,

Chau²,

Tam³

et al. 2023

COPD

View full text Add to dashboard Cite

Background: Chronic obstructive pulmonary disease (COPD) phenotyping using stable-state blood eosinophil level was shown to have prognostic implication in terms of exacerbation risk. However, using a single cut-off of blood eosinophil level to predict clinical outcome has been challenged. There have been suggestions that variability of blood eosinophil count at stable-state could provide additional information on exacerbation risk. Methods: A retrospective cohort study was conducted in a major regional hospital and a tertiary respiratory referral centre in Hong Kong, including 275 Chinese patients with COPD, to investigate the possible role of variability of blood eosinophil count at stable-state to predict COPD exacerbation risk in one year. Results: Higher variability of baseline eosinophil count, which is defined as the difference of the minimal and maximal eosinophil count at stable-state, was associated with increased risk of COPD exacerbation in the follow-up period with adjusted OR (aOR) of 1.001 (95% CI = 1.000-1.003, p-value = 0.050) for 1 unit (cells/µL) increase in variability of baseline eosinophil count, aOR of 1.72 (95% CI = 1.00-3.58, p-value = 0.050) for 1 SD increase in variability of baseline eosinophil count and aOR of 1.06 (95% CI = 1.00-1.13) for 50 cells/µL increase in variability of baseline eosinophil count. The AUC by ROC analysis was 0.862 (95% CI = 0.817-0.907, p-value < 0.001). The cut-off for variability of baseline eosinophil count identified was 50 cells/µL, with sensitivity of 82.9% and specificity of 79.3%. Similar findings were also shown in the subgroup with stable-state baseline eosinophil count below 300 cells/µL. Conclusion: Variability of baseline eosinophil count at stable-state might predict the exacerbation risk of COPD, exclusively among patients with baseline eosinophil count below 300 cells/µL. The cut-off value for variability was 50 cells/µValidation of the study findings in large scale prospective study would be meaningful.

show abstract

“…11 In combination with an exacerbation history, a high blood eosinophil count is a predictive biomarker that helps to identify patients who would benefit from ICS treatment. 72,73 However, the definition of high blood eosinophils has been debated, [74][75][76][77][78][79] and greater variability has been reported at higher eosinophil thresholds. 80,81 The GOLD 2023 report recommends that patients with a blood eosinophil count ⩾300 cells/μL and frequent or severe exacerbations (⩾2 moderate exacerbations or ⩾1 requiring hospitalization per year) should be treated with ICS in addition to LABA/LAMA.…”

Section: Phenotype 2: Patients Still Exacerbating Despite Laba/lama A...mentioning

confidence: 99%

Stepwise management of COPD: What is next after bronchodilation?

Miravitlles,

Matsunaga,

Dreher

2023

Ther Adv Respir Dis

View full text Add to dashboard Cite

Inhaled bronchodilator therapy with long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs) in combination is currently the mainstay of treatment for chronic obstructive pulmonary disease (COPD). Treatment guidelines recommend the addition of inhaled corticosteroids (ICS) to LABA/LAMA only in patients with a history of frequent/severe exacerbations and high blood eosinophil counts, or in those with concomitant asthma. Despite this, real-world data suggest that clinicians are not adhering to this guidance and that ICS are frequently overused. This is possibly due to the incorrect assumption that when LABA/LAMA therapy is not sufficient, adding an ICS to the treatment regimen is the logical next step. In this narrative review, we describe global and country-specific guideline recommendations from Germany, Spain, and Japan and compare these with real-world data on LABA/LAMA and ICS use in clinical practice. We also provide a clinical guide to the use of add-on therapies with LABA/LAMA for different patient phenotypes, including (1) patients still symptomatic (but not exacerbating) despite LABA/LAMA treatment; (2) patients still exacerbating despite LABA/LAMA treatment who have high blood eosinophil counts; and (3) patients still exacerbating despite LABA/LAMA treatment who do not have high blood eosinophils or concomitant asthma.

show abstract

Blood eosinophil count variability in chronic obstructive pulmonary disease and severe asthma

Cited by 10 publications

References 36 publications

Association between blood eosinophil count and small airway eosinophils in smokers with and without COPD

Association between blood eosinophil count and small airway eosinophils in smokers with and without COPD

Variability of Blood Eosinophil Count at Stable-State in Predicting Exacerbation Risk of Chronic Obstructive Pulmonary Disease

Stepwise management of COPD: What is next after bronchodilation?

Contact Info

Product

Resources

About