Abstract
Treating patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease (COPD) usually involves administering systemic corticosteroids. The many unwanted side effects associated with this treatment have led to increased interest in minimising the accumulated corticosteroid dose necessary to treat exacerbations. Studies have shown that short-term treatment with corticosteroids is preferred, and recent trials have shown that biomarkers can be used to further reduce exposure to corticosteroids. Interestingly, high eosinophil counts in patients with acute exacerbations of COPD are indicative of an eosinophilic phenotype with a distinct response to treatment with corticosteroids. In addition, post-hoc analysis of randomised control trials have shown that higher blood eosinophil counts at the start of the study predict a greater response to inhaled corticosteroids in stable COPD. In this review, we examine the studies on this topic, describe how blood eosinophil cell count may be used as a biomarker to guide treatment with corticosteroids, and identify some relevant challenges.
Highlights
Personalised treatment and precision medicine have recently attracted much interest due to their potential benefits, which include decreasing the administration of unnecessary treatments and identifying patients who may benefit most from specific medications.A personalised approach to treatment may be guided by genetic information, monitoring relevant clinical events or using biomarkers [1].Chronic obstructive pulmonary disease (COPD) is a common disorder which is characterised by progressive airflow limitation due to noxious particles, such as cigarette smoke [2]
This review focuses on the eosinophilic COPD
This study showed that the greatest reduction in exacerbations occurred in patients with high blood eosinophil counts, suggesting that this group responded better to treatment with inhaled corticosteroids (ICS) [74]
Summary
Personalised treatment and precision medicine have recently attracted much interest due to their potential benefits, which include decreasing the administration of unnecessary treatments and identifying patients who may benefit most from specific medications. Eosinophil granulocytes are cells of the immune system that release antimicrobial granules and produce cytokines that play a role in the defence against parasites and participate in allergic reactions [4]. Their levels are increased in patients with inflammatory diseases such as asthma, allergic rhinitis and several skin diseases [5]. Corticosteroids are anti-inflammatory drugs that are indicated in both stable COPD and at exacerbation [2] Due to their potential short and long-term side effects, a simple biomarker associated with a beneficial treatment response to corticosteroids in patients with COPD would be extremely valuable. This review focuses on the eosinophilic COPD phenotype, and whether using blood eosinophil levels as a biomarker may decrease the exposure to corticosteroids in patients with COPD
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