Abstract
Background and objectiveInhaled corticosteroid (ICS) therapy for COPD should be guided by exacerbations and blood-eosinophils according to the GOLD 2020 strategy document. In the present study, we applied these recent recommendations in a large cohort of COPD patients recruited from general practice.MethodsThe participating general practitioners (n = 144) recruited patients with a diagnosis of COPD currently prescribed ICS and reported data on exacerbation history and blood-eosinophils. Clinical variables were compared using two-sample t-tests.ResultsThe study cohort comprised 1,567 COPD patients (44% males and mean age 72 years). In the past 12 months, 849 (54%) of the COPD patients currently prescribed ICS had no exacerbation, whereas 383 (24%) and 328 (21%) patients, respectively, had a history of one exacerbation and two or more exacerbations. Compared to patients with one or no exacerbation, patients with ≥ 2 exacerbations (21%) per year reported more dyspnea (p < 0.001) and had higher degree of airflow obstruction (p < 0.001). Among patients with no and at least one exacerbation within the preceding 12 months, 30% and 26%, respectively, had a blood-eosinophil count ≥ 0.3 × 109/L. In patients with two or more exacerbations within the last 12 months, 77% had a blood-eosinophil count of ≥ 0.1 × 109/L. Furthermore, 166 patients (11%) had at least one hospital admission due to COPD exacerbation, and a blood-eosinophil count of ≥ 0.1 × 109/L.ConclusionThis study of a large cohort of COPD patients currently prescribed inhaled corticosteroids suggests the need for re-evaluating the management strategy to increase benefit and reduce adverse effects of ICS treatment in COPD patients managed in primary care.
Highlights
The 2020 strategy document by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends maintenance therapy with inhaled corticosteroids (ICS)Savran et al Respir Res (2021) 22:54 status in Chronic obstructive pulmonary disease (COPD) patients [4]
Other studies support this proposal and conclude that COPD patients with frequent exacerbations and higher blood-eosinophil counts have reduced exacerbations on ICS treatment, though firm conclusions are limited due to arbitrary cut-off of blood-eosinophil count [10, 12]. In this population-based cohort of COPD patients followed in primary care, our aim was to apply recent proposals from the GOLD strategy document, which indicates that ICS therapy should be guided by exacerbations and blood-eosinophils
Compared to patients with < 2 exacerbations patients with ≥2 exacerbations (21%) per year had higher MRCscore (p
Summary
The 2020 strategy document by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends maintenance therapy with inhaled corticosteroids (ICS). Savran et al Respir Res (2021) 22:54 status in COPD patients [4]. This combination therapy is often prescribed as an initial treatment regardless of COPD severity [4]. ICS treatment has been associated with a high risk of pneumonia in COPD patients [5, 6]. Recent studies indicate that patients with elevated blood-eosinophil count have higher risk of COPD exacerbations [7, 8]. Inhaled corticosteroid (ICS) therapy for COPD should be guided by exacerbations and blood-eosinophils according to the GOLD 2020 strategy document. We applied these recent recommendations in a large cohort of COPD patients recruited from general practice
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