Abstract
The employment of systemic corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD) has been shown to improve airway limitation, decrease treatment failure and risk of relapse, and may improve symptoms in addition to decreasing the length of hospital stay. Nowadays, all clinical guidelines recommend systemic corticosteroids to treat moderate or severe COPD exacerbations. However, their use is associated with potential side effects, mainly hyperglycemia. In the era of precision medicine, the possibility of employing blood eosinophil count has emerged as a potential way of optimizing therapy. Issues regarding the intra-individual variability of blood eosinophil count determination, a lack of clear data regarding the real prevalence of eosinophilic acute exacerbations, the fact that previously published studies have demonstrated the benefit of systemic corticosteroids irrespective of eosinophil levels, and especially the fact that there is only one well-designed study justifying this approach have led us to think that we are not ready to use eosinophil count to guide treatment with systemic corticosteroids during acute exacerbations of COPD.
Highlights
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide [1]
They found that after 10 days of treatment, patients treated with systemic corticosteroids had greater improvements in lung function, less dyspnea and better quality of life based on the determinations of the chronic respiratory disease questionnaire (CRQ)
Ever since studies in the early nineties [29] suggested that exacerbations of chronic bronchitis were associated with marked airway eosinophilia, eosinophilic airway inflammation has been classically associated with asthma
Summary
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide [1]. The course of COPD is characterized by episodes of increased symptoms known as exacerbations that, when severe enough, regularly require additional treatments. Patients with repeated exacerbations or with exacerbations that require hospitalization have been associated with an increased risk of morbidity and mortality [2,5,6]. Those with less severe exacerbations are often managed as outpatients, COPD exacerbations may require hospitalization. 2018, 6, 49 is a significant contributor to the economic burden of COPD [7], COPD hospitalization is what most contributes to the global cost of the disease [8,9] Sci. 2018, 6, 49 is a significant contributor to the economic burden of COPD [7], COPD hospitalization is what most contributes to the global cost of the disease [8,9]
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