Blood Eosinophil Counts and Their Variability and Risk of Exacerbations in COPD: A Population-Based Study

Miravitlles, Marc; Monteagudo, Mónica; Solntseva, Iryna; Alcázar, Bernardino

doi:10.1016/j.arbres.2019.12.015

Cited by 49 publications

(49 citation statements)

References 47 publications

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“…In this analysis, 20.1% had eosinophil counts above this threshold. These results are in line with other studies that suggest that around 25% of patients have eosinophil counts higher than 300 cells/μL [12,19,39].…”

Section: Discussionsupporting

confidence: 93%

“…In this pooled analysis of 22,125 patients with COPD, we did not find a clinically important relationship between baseline blood eosinophil count and exacerbation rate. This analysis, coupled with other studies on this topic [18,19], indicate that blood eosinophil counts are not a clinically useful predictor of future exacerbation risk.…”

Section: Resultsmentioning

confidence: 70%

“…However, a retrospective study of 992 patients with COPD by Adir et al found that, among patients who experienced severe exacerbations (72%) and those that did not (71%), there was no difference in the proportion of patients with eosinophil counts of ≥ 2% (P = 0.93) [18]. Similarly, a recent population-based study in 57,209 patients with COPD did not find any relationship between blood eosinophil count and risk of exacerbations [19].…”

Section: Discussionmentioning

confidence: 96%

“…Consequently, blood eosinophil counts have utility in clinical practice to direct ICS use in COPD patients, and as a biomarker in clinical trials to identify subgroups with different responses to antiinflammatory drugs [14]. However, publications investigating the relationship between blood eosinophils and exacerbation risk have produced conflicting results [15][16][17][18][19]. Some observational cohort studies have reported that higher eosinophil levels are associated with future COPD exacerbations [15][16][17], but other studies suggest that there is no relationship [18,19].…”

Section: Introductionmentioning

confidence: 99%

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Blood eosinophils as a biomarker of future COPD exacerbation risk: pooled data from 11 clinical trials

et al. 2020

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Background Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow limitation and chronic inflammation. Predicting exacerbations of COPD, which contribute to disease progression, is important to guide preventative treatment and improve outcomes. Blood eosinophils are a biomarker for patient responsiveness to inhaled corticosteroids (ICS); however, their effectiveness as a predictive biomarker for COPD exacerbations is unclear. Methods This post hoc analysis pooled data from 11 Boehringer Ingelheim-sponsored Phase III and IV randomised COPD studies with similar methodologies. Exacerbation data were collected from these studies, excluding patients from the ICS withdrawal arm of the WISDOM® study. Patients were grouped according to their baseline blood eosinophil count, baseline ICS use and number of exacerbations in the year prior to each study. Results Exacerbation rate data and baseline eosinophil count were available for 22,125 patients; 45.6% presented with a baseline blood eosinophil count of ≤ 150 cells/μL, 34.3% with 150–300 cells/μL and 20.1% with > 300 cells/μL. The lowest exacerbation rates were observed in patients with ≤ 150 cells/μL, with small increases in exacerbation rate observed with increasing eosinophil count. When stratified by exacerbation history, the annual rate of exacerbations for patients with 0 exacerbations in the previous year increased in line with increasing eosinophil counts (0.38 for ≤ 150 cells/μL, 0.39 for 150–300 cells/μL and 0.44 for > 300 cells/μL respectively). A similar trend was identified for patients with one exacerbation in the previous year, 0.62, 0.66 and 0.67 respectively. For patients with ≥ 2 exacerbations, exacerbation rates fluctuated between 1.02 (≤ 150 cells/μL) to 1.10 (150–300 cells/μL) and 1.07 (> 300 cells/μL). Higher exacerbation rates were noted in patients treated with ICS at baseline (range 0.75 to 0.82 with increasing eosinophil count) compared with patients not on ICS (range 0.45 to 0.49). Conclusion We found no clinically important relationship between baseline blood eosinophil count and exacerbation rate. Hence, the current analysis does not support the use of blood eosinophils to predict exacerbation risk; however, previous exacerbation history was found to be a more reliable predictor of future exacerbations. Trial registration ClinicalTrials.gov Identifiers: NCT00168844, NCT00168831, NCT00387088, NCT00782210, NCT00782509, NCT00793624, NCT00796653, NCT01431274, NCT01431287, NCT02296138 and NCT00975195. Graphical abstract

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Section: Discussionsupporting

confidence: 93%

Section: Resultsmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Blood eosinophils as a biomarker of future COPD exacerbation risk: pooled data from 11 clinical trials

et al. 2020

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“…10,11 Studies based on databases of medical records are increasingly used in clinical research, and since they represent real-life clinical practice, they may help to detect gaps or inadequacies in diagnosis and treatment. 12 In this context, we performed the present study with the aim of exploring the patterns of AATD diagnosis and their evolution over the last 5 years. The results will help to design programmes to increase awareness about the diagnosis of AATD.…”

Section: Introductionmentioning

confidence: 99%

<p>Trends in Diagnosis of Alpha-1 Antitrypsin Deficiency Between 2015 and 2019 in a Reference Laboratory</p>

Belmonte

Núñez

Barrecheguren

et al. 2020

COPD

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Background: Alpha-1 antitrypsin deficiency (AATD) remains largely underdiagnosed despite recommendations of healthcare institutions and programmes designed to increase awareness. The objective was to analyse the trends in AATD diagnosis during the last 5 years in a Spanish AATD reference laboratory. Methods: This was a retrospective revision of all alpha-1 antitrypsin (AAT) determinations undertaken in our laboratory from 2015 to 2019. We analysed the number of AAT determinations performed and described the characteristics of the individuals tested, as well as the medical specialties and the reasons for requesting AAT determination. Results: A total of 3507 determinations were performed, of which 5.5% corresponded to children. A significant increase in the number of AAT determinations was observed from 349 in 2015 to 872 in 2019. Among the samples, 57.6% carried an intermediate AATD (50-119 mg/dL) and 2.4% severe deficiency (<50 mg/dL). The most frequent phenotype in severe AATD individuals was PI*ZZ (78.5%), and aminotransferase levels were above normal in around 43% of children and 30% of adults. Respiratory specialists requested the highest number of AAT determinations (31.5%) followed by digestive diseases and internal medicine (27.5%) and primary care physicians (19.7%). The main reason for AAT determination in severe AATD adults was chronic obstructive pulmonary disease (41.7%), but reasons for requesting AAT determination were not reported in up to 41.7% of adults and 58.3% of children. Conclusion: There is an increase in the frequency of AATD testing despite the rate of AAT determination remaining low. Awareness about AAT is probably increasing, but the reason for testing is not always clear.

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Treatment Pathways Before and After Triple Therapy in COPD: A Population-based Study in Primary Care in Spain

Monteagudo

Núñez

Solntseva

et al. 2021

Archivos de Bronconeumología (English Edition)

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Blood Eosinophil Counts and Their Variability and Risk of Exacerbations in COPD: A Population-Based Study

Cited by 49 publications

References 47 publications

Blood eosinophils as a biomarker of future COPD exacerbation risk: pooled data from 11 clinical trials

Blood eosinophils as a biomarker of future COPD exacerbation risk: pooled data from 11 clinical trials

<p>Trends in Diagnosis of Alpha-1 Antitrypsin Deficiency Between 2015 and 2019 in a Reference Laboratory</p>

Treatment Pathways Before and After Triple Therapy in COPD: A Population-based Study in Primary Care in Spain

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