Risk of Exacerbation in COPD: Where Is Right Way to Go for Identification?

Abstract

SESSION TITLE: Airways 3 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: The risk of exacerbation in chronic obstructive pulmonary disease (COPD)depends on the severity of disease and other less well known factors.Predictive models of exacerbation are more accurate than the forced expiratory volume in one second(FEV1).Whether high blood eosinophils are associated with COPD exacerbations among individuals with COPD in the general population is known.The aim our study was to assess the the systemic( blood eosinophilia,C-reactive protein,periostin) and pulmonary inflammatory biomarkers( exhaled FeNO ,sputum eosinophilia and neutrophlia) as predictors for exacerbations of severe COPD. METHODS: From January 2013 to March 2015 139 inhospital severe COPD patients with exacerbations who admiddted to the pulmonary medicine department of Medical university Hospital were included to our study.Depends on elevation of inflammatory biomarkers all patients were divided into two groups:1) 82 patients with non-eosinophilic COPD exacerbations ;2)57 patients with eosinophilic COPD exacerbations.In all patients were investigated arterial bloog gas,pulmonary function,cell content of induced spurtum,microbiologic test of sputum,CT scan of lung ,plasma level of periostin and CRP and exhaled FeNO. RESULTS: Our investigation shown that in patients the high level of CRP(60±14.7mg/l vs 15±2.9 in patients second group;p<0.001) was associated with low level of blood eosinophils (1.3±0.4 %vs 6.8±2.5% in patients second group;p<0.003) and although same association was noted according to plasma level of periostin(17±4.8 ng/ml vs 79±19.4ng/ml in patients second group;p<0.0003).High level of CRP also was associated with poor outcomes for patients.In this group patients more often was noted hypercapnic respiratory failure needed to non-invasive ventilation(NIV) and intensive care unit(ICU) addmission (p<0.001) than in patients with eosinophilic COPD exacerbations.In patients with high level of blood eosinophilia(>260/μl) was correlated with high plasma level of periostin(>45 ng/ml) with good response to the systemic (oral prednisolone) and local(budesonide and flixotide) corticosteroids and without respiratory failure(p<0.001 comparison with first group patients).In contrast to these in patients with high level of CRP more common was bacterial colonization with development of community-aquiered pneumona(CAP;p<0.001).High blood eosinophilia and high plasma periostin were assiciated with high level sputum eosinophils and high concentration of exhaled FeNO. CONCLUSIONS: High blood eosinophilia and high plasma periostin were associated with increased rate of exacerbations in severe COPD patients with good response to oral systemic and local corticosteriods and without ICU addmission.In contrast to those high level of plasma CRP was associated with bacterial colonization with development of CAP and hypercapnic respiratory failure provided by NIV and ICU addmission.High level blood eosinophilia and high plasma periostin level were correlated with high level of sputum eosinophils and high concentration of FeNO.Definition of inflammatory systemic and local biomarkers may help us for right management of exacerbations of patients with severe COPD. CLINICAL IMPLICATIONS: Clinicians,respiratory therapeutists,ICU physicians DISCLOSURE: The following authors have nothing to disclose: Alizamin Sadigov No Product/Research Disclosure Information