Stability of Blood Eosinophils in Patients with Chronic Obstructive Pulmonary Disease and in Control Subjects, and the Impact of Sex, Age, Smoking, and Baseline Counts

Oshagbemi, Olorunfemi A.; Burden, Andrea M.; Braeken, Dionne C.W.; Henskens, Yvonne; Wouters, Emiel F.M.; Driessen, Johanna H M; Zee, Anke‐Hilse Maitland‐van der; Vries, Frank de; Franssen, Frits M.E.

doi:10.1164/rccm.201701-0009le

Cited by 113 publications

(117 citation statements)

References 10 publications

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“…It is also known that the BEC is not stable in the long term, as demonstrated in longitudinal studies performing repeated determinations of these counts, in which it was observed that, although most patients had persistently high or low levels, a group of them could be classified on some occasions in the elevated BEC group, and on others in the low BEC group …”

Section: Discussionmentioning

confidence: 99%

“…22 It is also known that the BEC is not stable in the long term, as demonstrated in longitudinal studies performing repeated determinations of these counts, in which it was observed that, although most patients had persistently high or low levels, a group of them could be classified on some occasions in the elevated BEC group, and on others in the low BEC group. 12,25,[35][36][37] The fact that patients with higher BEC have a higher risk of late readmissions should be considered in order to decide on both their treatment at discharge and the scheduled follow-up after their discharge.…”

Section: Ta B L E 1 (Continued)mentioning

confidence: 99%

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Blood eosinophils could be useful as a biomarker in chronic obstructive pulmonary disease exacerbations

Barcala

San-Jose²,

Nieto‐Fontarigo

et al. 2019

Int J Clin Pract

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Summary IntroductionThe aim of analysing the usefulness of the blood eosinophil count (BEC) as a prognostic marker in exacerbations of patients with Chronic Obstructive Pulmonary Disease (COPD), evaluating its relationship with hospital mortality, the length of stay and the early and late re‐admissions. Materials and MethodsWe have carried out a retrospective study including all patients who required hospital admission from 1 January 2008 to 31 December 2009, with a diagnosis on hospital discharge of COPD exacerbation. These patients were classified using three cut‐off points of BEC: less than 200 vs ≥ 200/µL, less than 300 vs ≥ 300/µL and less than 400 vs ≥ 400/µL. ResultsThere were a total of 1626 hospital admissions during the study period with the diagnosis of exacerbation of COPD. In this study we have included 358 patients. The probability of any late re‐admission increased with a BEC ≥ 300/µL (odds ratio: 1.684) and for those with a BEC ≥ 400/µL (odds ratio: 2.068). The BEC does not appear to be related to hospital mortality or the probability of early re‐admission after an exacerbation of COPD. ConclusionsIn our study an elevated BEC is associated with a higher incidence of late hospital readmissions in COPD exacerbations.

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Section: Discussionmentioning

confidence: 99%

Section: Ta B L E 1 (Continued)mentioning

confidence: 99%

Blood eosinophils could be useful as a biomarker in chronic obstructive pulmonary disease exacerbations

Barcala

San-Jose²,

Nieto‐Fontarigo

et al. 2019

Int J Clin Pract

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“…One problem is that blood eosinophils counts are variable over time and even within the same day, so that it is important to make repeated measurements. In a large population of COPD patients, approximately 30% had blood eosinophils >340/μL, compared to 25% in normal subjects but increased counts were unstable, particularly in elderly patients . In a large population of COPD patients in general practice the variability in blood eosinophils with multiple testing (at least 3 measurements) and exclusion of patients on oral corticosteroids or antibiotics was greater at higher eosinophil counts; 88% with an initial eosinophil count ≥150/μL had a subsequent mean value ≥150/μL, whereas those with the initial count ≥300 cells/μL subsequent counts above this level were 68% .…”

Section: Eosinophilic Copdmentioning

confidence: 94%

Inflammatory endotypes in COPD

Barnes

2019

Allergy

197

155

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Chronic obstructive pulmonary disease (COPD) is a major global health problem that is poorly treated by current therapies as it has proved difficult to treat the underlying inflammation, which is largely corticosteroid-resistant in most patients. Although rare genetic endotypes of COPD have been recognized, despite the clinical heterogeneity of COPD, it has proved difficult to identify distinct inflammatory endotypes.Most patients have increased neutrophils and macrophages in sputum, reflecting the increased secretion of neutrophil and monocyte chemotactic mediators in the lungs.However, some patients also have increased eosinophils in sputum and this may be reflected by increased blood eosinophils. Increased blood and sputum eosinophils are associated with more frequent exacerbations and predict a good response to corticosteroids in reducing and treating acute exacerbations. Eosinophilic COPD may represent an overlap with asthma but the mechanism of eosinophilia is uncertain as, although an increase in sputum IL-5 has been detected, anti-IL-5 therapies are not effective in preventing exacerbations. More research is needed to link inflammatory endotypes to clinical manifestations and outcomes in COPD and in particular to predict response to precision medicines. K E Y W O R D Sasthma-COPD overlap, eosinophil, exacerbations, interleukin-5, macrophage, neutrophil

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“…Elevated IgE concentrations are found in up to half of patients with COPD, 24 25 and eosinophilic subtypes of COPD are well described in the literature. [26][27][28][29][30] The debate about which level of peripheral eosinophil count to ascribe to ACOS, whether above 2%, 3%, 5%, or instead using an absolute measurement, has also not been resolved. [21][22][23][24][25][26][27][28][29][30][31][32][33] A FeNO cut-off of above 35 ppb may correlate with a post-bronchodilator FEV 1 response greater than 200 mL and atopy in patients with COPD, 25 34 but the few studies that have looked at FeNO in ACOS seem to offer conflicting evidence of the test's discriminatory power.…”

Section: Introductionmentioning

confidence: 99%

Asthma-COPD overlap syndrome: pathogenesis, clinical features, and therapeutic targets

Leung

Sin

2017

BMJ

138

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Asthma-COPD overlap syndrome (ACOS) or asthma-COPD overlap captures the subset of patients with airways disease who have features of both asthma and chronic obstructive pulmonary disease (COPD). Although definitions of ACOS vary, it is generally thought to encompass persistent airflow limitation in a patient older than 40 years of age with either a history of asthma or large bronchodilator reversibility. ACOS affects about a quarter of patients with COPD and almost a third of patients who previously had asthma. Compared with their counterparts with asthma or COPD alone, patients with ACOS have significantly worse respiratory symptoms, poorer quality of life, and increased risk of exacerbations and hospital admissions. Whether this condition emerges after gradual shifts in airway remodelling and inflammation in a patient with COPD, as the result of noxious exposures in a patient with asthma, or even as a de novo disease with its own pathology is yet to be determined. Nevertheless, using treatments developed for asthma or COPD that target eosinophilic, neutrophilic, or paucigranulocytic airway inflammation may be a helpful approach to these patients until further clinical trials can be performed.

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Stability of Blood Eosinophils in Patients with Chronic Obstructive Pulmonary Disease and in Control Subjects, and the Impact of Sex, Age, Smoking, and Baseline Counts

Cited by 113 publications

References 10 publications

Blood eosinophils could be useful as a biomarker in chronic obstructive pulmonary disease exacerbations

Blood eosinophils could be useful as a biomarker in chronic obstructive pulmonary disease exacerbations

Inflammatory endotypes in COPD

Asthma-COPD overlap syndrome: pathogenesis, clinical features, and therapeutic targets

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