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

Singh, Dave; Wedzicha, Jadwiga A.; Siddiqui, Salman; Hoz, Alberto de la; Xue, Wen‐Qiong; Magnussen, H; Miravitlles, Marc; Chalmers, James D.; Calverley, Peter M.A.

doi:10.1186/s12931-020-01482-1

Cited by 38 publications

(27 citation statements)

References 38 publications

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“…also found no solid association between BEC and the risk of AECOPD: they reported a trend towards lower rates of AECOPD in patients with ≤150 cells/µL, although their results may have been impacted by the use of corticosteroids. They did consider previous exacerbations as the best predictor of future exacerbations, which is consistent with the existing literature [ 39 ].…”

Section: Discussionsupporting

confidence: 85%

Variability of blood eosinophil count and prognosis of COPD exacerbations

Martínez-Gestoso¹,

García-Sanz²,

Calvo-Álvarez

et al. 2021

Annals of Medicine

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Background: Eosinophils in peripheral blood are one of the emerging biomarkers in chronic obstructive pulmonary disease (COPD) patients. However, when analysing the relationship between peripheral eosinophilia and COPD prognosis, highly variable results are obtained. The aim of our study is to describe the serum eosinophilia levels in COPD patients and to analyse their relationship to prognosis following hospital admission. Methods: A prospective observational study was conducted from 1 October 2016 to 1 October 2018 in the following Spanish centres: Saln es County Hospital in Vilagarc ıa de Arousa, Arquitecto Marcide Hospital in Ferrol and the University Hospital Complex in Santiago de Compostela. The patients were classified using three cut-off points of blood eosinophil count (BEC): 150 cells/mL, 300 cells/mL, and 400 cells/mL; in addition, the peripheral BEC was analysed on admission. Results: 615 patients were included in the study, 86.2% male, mean age 73.9 years, and mean FEV1 52.7%. The mean stay was 8.4 days, and 6% of all patients were readmitted early. No significant relationship was observed between the BEC, neither in the stable phase nor in the acute phase, and hospital stay, readmissions, deaths during admission, the need for intensive care, or the condition of frequent exacerbator. Conclusion:The results of our study do not seem to support the usefulness of BEC as a COPD biomarker. KEY MESSAGES1. There is evidence that BEC participates in pathophysiological mechanisms of the COPD. 2. BEC may be useful as a biomarker in COPD for aspects such as the optimization of treatments. 3. We did not find any relationship between BEC levels and prognosis following hospital admission for AECOPD.

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Section: Discussionsupporting

confidence: 85%

Variability of blood eosinophil count and prognosis of COPD exacerbations

Martínez-Gestoso¹,

García-Sanz²,

Calvo-Álvarez

et al. 2021

Annals of Medicine

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“…The EMAX randomized trial conducted in low exacerbation risk patients with COPD not receiving ICS showed that there was no difference in the occurrence of severe exacerbations between the umeclidinium/vilanterol and umeclidinium treatment groups ( Maltais et al, 2019 ). It is known that previous exacerbation history is a reliable predictor of future exacerbations ( Singh et al, 2019 ; Singh et al, 2020 ). In our study, the LAMA group had a higher proportion of patients with a history of exacerbations during the previous year than patients treated with LABA/LAMA (65.7 vs. 52.3%, p = 0.016).…”

Section: Discussionmentioning

confidence: 99%

Real-World Effectiveness of Inhalation Therapy Among Patients With Symptomatic COPD in China: A Multicenter Prospective Study

et al. 2021

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Purpose: This real-world study evaluated the effectiveness of different inhalation therapies in patients with symptomatic chronic obstructive pulmonary disease (COPD) in China and also explored the relevant factors that influence the effectiveness of inhalation therapy.Patients and Methods: We conducted a multicenter prospective longitudinal study that was carried out in 12 hospitals in China from December 2016 to June 2021. A face-to-face interview was conducted to collect data. Baseline data were collected at the first visit. Minimum clinically important difference (MCID) was defined as attaining a COPD assessment test (CAT) decrease ≥2. We mainly assessed the MCID and the incidence of exacerbations at the 6 months follow-up.Results: In 695 patients, the mean age was 62.5 ± 8.2 years, with a mean CAT score of 15.1 ± 6.0. Overall, 341 (49.1%) patients attained the MCID of CAT and the incidence of exacerbation during follow-up was 22.3%. Females were significantly more likely to attain MCID than male in COPD patients (adjusted odd ratio (aOR) = 1.93, adjusted 95% confidence interval (a95%CI) = 1.09–3.42, p = 0.024). Patients treated with LABA/LAMA or ICS/LABA/LAMA (ICS, inhaled corticosteroid; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist) were more likely to attain MCID than patients treated with LAMA (aOR = 3.97, a95%CI = 2.48–6.35, p < 0.001; aOR = 3.17, a95%CI = 2.09–4.80, p < 0.001, respectively). Patients treated with LABA/LAMA had a higher incidence of severe exacerbation than patients treated with ICS/LABA/LAMA (aOR = 1.95, a95%CI = 1.04–3.66, p = 0.038).Conclusion: The incidence of MCID in symptomatic COPD patients treated with inhalation therapy was nearly 50%. Patients treated with LABA/LAMA or ICS/LABA/LAMA were more likely to attain MCID than patients treated with LAMA. Patients treated with LABA/LAMA had a higher incidence of severe exacerbations than with ICS/LABA/LAMA.

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“…However, as in many areas in life, "the devil is in the details", and more data is needed before blood eosinophil levels can be used to identify a COPD phenotype amenable to specific immunomodulatory therapy. [7] 10. Variability of blood eosinophils as a biomarker in asthma and COPD Peter G. Gibson et al described to consider are those that lower the count and could lead to a false-negative test for diagnosis of the eosinophilic phenotype.…”

Section: We Can Use Eosinophils Like a Target And Biomarker In The Bimentioning

confidence: 99%

Eosinophils as a Biomarker in Asthma and COPD

Garcia¹

2020

Update in Respiratory Diseases

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Asthma and COPD are two diseases related to eosinophils. But at present, we do not know with certainty how much these cells participate in these diseases, beyond that the treatment of the underlying cause produces the resolution of eosinophilia in a “reactive” way. Eosinophil-related diseases are a spectrum of systemic diseases such as Asthma and COPD in pneumology area. Under inflammatory conditions, the number of circulating eosinophils or tissues can increase dramatically, with rapid development of eosinophilia and we can obtain in a simple laboratory test. In general, the number of eosinophils in the blood can provide useful information and considering the differential diagnosis and for the subsequent test of patients presenting with eosinophilia. The treatment of eosinophilia currently in number of 300 cells in which is the criteria and the target to be treat. The best known and most used of all treatments for diseases related to eosinophils are corticosteroids, which decrease circulating and tissue eosinophils in a few hours, through mechanisms that include the direct activation of eosinophil program death. Targeted treatment against eosinophils could improve airway remodeling through mechanisms that are not fully known, and their effects on lung function are variable and decreasing symptoms in patients.

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

Cited by 38 publications

References 38 publications

Variability of blood eosinophil count and prognosis of COPD exacerbations

Variability of blood eosinophil count and prognosis of COPD exacerbations

Real-World Effectiveness of Inhalation Therapy Among Patients With Symptomatic COPD in China: A Multicenter Prospective Study

Eosinophils as a Biomarker in Asthma and COPD

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