Abstract
The authors examined predictive properties and the longitudinal stability of blood eosinophil count (BEC) or three strata (<100 cells/mm3, 100–299 cells/mm3 and ≥300 cells/mm3) in patients with chronic obstructive pulmonary disease (COPD) for up to six and a half years as part of a hospital-based cohort study. Of the 135 patients enrolled, 21 (15.6%) were confirmed to have died during the follow-up period. Episodes of acute exacerbation of COPD (AECOPD) were identified in 74 out of 130 available patients (56.9%), and admission due to AECOPD in 35 out of 132 (26.5%). Univariate Cox proportional hazards analyses revealed that almost all the age, forced expiratory volume in 1 s (FEV1) and health status measures using St. George’s Respiratory Questionnaire (SGRQ) Total and COPD Assessment Test (CAT) Score were significantly related to these types of events, but the relationship between age and AECOPD did not reach statistical significance (p = 0.05). Neither BEC nor the three different groups stratified by BEC were significant predictors of any subsequent events. There were no significant differences in the BEC between Visits 1–3 (p = 0.127, Friedman test). The ICC value was 0.755 using log-transformed data, indicating excellent repeatability. In the case of assigning to strata, Fleiss’ kappa was calculated to be 0.464, indicating moderate agreement. The predictive properties of BEC may be limited in a real-world Japanese clinical setting. Attention must be paid to the fact that the longitudinal stability of the three strata is regarded as moderate.
Highlights
The question of whether inhaled corticosteroids (ICS) should be administered to patients with chronic obstructive pulmonary disease (COPD) has been debated for over three decades [1,2,3,4]
We aimed to investigate how blood eosinophil count (BEC), or the three strata are cross-sectionally related to other clinical measures at baseline and to examine predictive properties of the baseline values regarding mortality, acute exacerbation of COPD (AECOPD) and admission due to AECOPD
Eighty-three patients were treated with multiple-inhaler triple therapy, that is, a combination of long-acting muscarinic antagonist (LAMA) and beta2agonist (LABA) and inhaled corticosteroid (ICS), 33 patients with tiotropium bromide alone, 13 patients with ICS/LABA and 6 patients with no long-acting bronchodilators
Summary
The question of whether inhaled corticosteroids (ICS) should be administered to patients with chronic obstructive pulmonary disease (COPD) has been debated for over three decades [1,2,3,4]. Some post-hoc analyses of relatively largescale clinical trials for studying ICS-containing regimens in patients with moderate and severe COPD have reported that the BEC is significantly able to predict the response to ICS since this medication was most efficacious in the prevention of exacerbation in patients with higher baseline BEC [5,6,7]. This hypothesis was subsequently investigated in the development procedures of the single-inhaler triple therapy and the BEC was established as a prognostic biomarker [8,9,10]. To determine whether or not the BEC can be regarded as a biomarker in COPD, multifaceted analysis and evaluation as an outcome marker will be required
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