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Inhaled corticosteroid use by exacerbations and eosinophils: a real-world COPD population

Authors Vestbo J, Vogelmeier CF, Small M, Siddall J, Fogel R, Kostikas K

Received 3 October 2018

Accepted for publication 15 March 2019

Published 16 April 2019 Volume 2019:14 Pages 853—861


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Richard Russell

Jørgen Vestbo,1 Claus F Vogelmeier,2 Mark Small,3 James Siddall,3 Robert Fogel,4 Konstantinos Kostikas4,5

1Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK; 2Department for Pulmonary Medicine, Philipps-University of Marburg, Marburg, Germany; 3Respiratory Research, Adelphi Real World, Bollington, UK; 4Global Medical Affairs, Novartis Pharma AG, Basel, Switzerland; 5Respiratory Medicine Department, University of Ionnina Medical School, Ionnina, Greece

Background: Blood eosinophils may predict response to inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD) where ICS is recommended in patients at high risk of exacerbations. The proportion of patients who may benefit the most from ICS-based therapy was quantified in a real-world population.
Materials and methods: European data from the Adelphi Real World Respiratory Disease Specific Programme™ 2017 survey were collected from consecutive COPD patients by participating physicians. Overall, 1,528 patients were assessable for Global Initiative for COPD (GOLD) 2017 status and were included in the analysis.
Results: More GOLD D patients had elevated eosinophil counts compared with GOLD B. The proportions of GOLD D patients with a history of ≥2 exacerbations and eosinophil counts of ≥150, ≥300, and ≥400 cells/μL were 81.2%, 39.4%, and 24.6%, respectively. In total, 10.6% of the patients had ≥300 eosinophils/μL and a history of ≥2 exacerbations. ICS-based therapy was received by 41.5% of GOLD B and 68.0% of GOLD D patients.
Conclusion: There was no apparent relation between ICS use and eosinophil blood count. There are differences in the distributions of patients with frequent exacerbations and/or high blood eosinophil counts and the use of ICS in COPD. These data may provide information for the implementation of future treatment recommendations.

Keywords: COPD, exacerbations, inhaled corticosteroids, eosinophils, observational study

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