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Effectiveness using higher inhaled corticosteroid dosage in patients with COPD by different blood eosinophilic counts

View Article: PubMed Central - PubMed

ABSTRACT

Background: Blood eosinophil counts have been documented as a good biomarker for patients with chronic obstructive pulmonary disease (COPD) using inhaled corticosteroid (ICS) therapy. However, the effectiveness and safety of prescribing high or medium dose of ICS for patients with different eosinophil counts are unknown.

Methods: A post hoc analysis of a previous prospective randomized study was performed for COPD patients using higher dose (HD: Fluticasone 1,000 μg/day) or medium dose (MD: Fluticasone 500 μg/day) of ICS combined with Salmeterol (100 μg/day). Patients were classified into two groups: those with high eosinophil counts (HE ≥3%) and those with low eosinophil counts (LE <3%). Lung function was evaluated with forced expiratory volume in 1 second, forced vital capacity, and COPD assessment test. Frequencies of acute exacerbation and pneumonia were also measured.

Results: Two hundred and forty-eight patients were studied and classified into higher eosinophil (HE) (n=85, 34.3%) and lower eosinophil (LE) groups (n=163, 65.7%). The levels of forced expiratory volume in 1 second were significantly increased in patients of HE group treated with HD therapy, compared with the other groups (HE/HD: 125.9±27.2 mL vs HE/MD: 94.3±23.7 mL, vs LE/HD: 70.4±20.5 mL, vs LE/MD: 49.8±16.7 mL; P<0.05) at the end of the study. Quality of life (COPD assessment test) markedly improved in HE/HD group than in MD/LE group (HE/HD: 9±5 vs LE/MD: 16±7, P=0.02). The frequency of acute exacerbation was more decreased in HE/HD group patients, compared with that in LE/MD group (HE/HD: 13.5% vs LE/MD: 28.7%, P<0.01). Pneumonia incidence was similar in the treatment groups (HE/HD: 3.2%, HE/MD: 2.6%, LE/HD: 3.5%, LE/MD 2.8%; P=0.38).

Conclusion: The study results support using blood eosinophil counts as a biomarker of ICS response and show the benefits of greater improvement of lung function, quality of life, and decreased exacerbation frequency in COPD patients with blood eosinophil counts higher than 3%, especially treated with higher dose of ICS.

No MeSH data available.


Lung function improvement with FEV1 in HE and LE patients using HD and MD therapy.Abbreviations: FEV1, forced expiratory volume in 1 second; HD, high dose; HE, higher eosinophil count; LE, lower eosinophil count; MD, medium dose.
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f2-copd-11-2341: Lung function improvement with FEV1 in HE and LE patients using HD and MD therapy.Abbreviations: FEV1, forced expiratory volume in 1 second; HD, high dose; HE, higher eosinophil count; LE, lower eosinophil count; MD, medium dose.

Mentions: Analysis of the pulmonary function status with FEV1 and FVC revealed that patients showed improvements in lung function across both treatment groups during the study. The improved FEV1 levels among these patients were as follows: HE/HD: 125.9±27.2 mL versus HE/MD: 94.2±23.7 (P<0.05), versus LE/HD: 70.4±20.5 (P=0.03), and versus LE/MD: 49.8±16.7 (P<0.01). The levels of FVC were as follows: HE/HD: 248.4±51.3 mL versus HE/MD: 198.6±48.1 (P<0.05), versus LE/HD: 145.2±47.5 (P=0.02), and versus LE/MD: 82.6±44.3 (P<0.01). There was more significant lung function improvement in HE/HD patients when compared to that in patients of other groups (Figures 2 and 3). Patients receiving higher doses of Fluticasone showed greater efficacy in improvement of lung function, especially the patients also having high eosinophil counts.


Effectiveness using higher inhaled corticosteroid dosage in patients with COPD by different blood eosinophilic counts
Lung function improvement with FEV1 in HE and LE patients using HD and MD therapy.Abbreviations: FEV1, forced expiratory volume in 1 second; HD, high dose; HE, higher eosinophil count; LE, lower eosinophil count; MD, medium dose.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5036601&req=5

f2-copd-11-2341: Lung function improvement with FEV1 in HE and LE patients using HD and MD therapy.Abbreviations: FEV1, forced expiratory volume in 1 second; HD, high dose; HE, higher eosinophil count; LE, lower eosinophil count; MD, medium dose.
Mentions: Analysis of the pulmonary function status with FEV1 and FVC revealed that patients showed improvements in lung function across both treatment groups during the study. The improved FEV1 levels among these patients were as follows: HE/HD: 125.9±27.2 mL versus HE/MD: 94.2±23.7 (P<0.05), versus LE/HD: 70.4±20.5 (P=0.03), and versus LE/MD: 49.8±16.7 (P<0.01). The levels of FVC were as follows: HE/HD: 248.4±51.3 mL versus HE/MD: 198.6±48.1 (P<0.05), versus LE/HD: 145.2±47.5 (P=0.02), and versus LE/MD: 82.6±44.3 (P<0.01). There was more significant lung function improvement in HE/HD patients when compared to that in patients of other groups (Figures 2 and 3). Patients receiving higher doses of Fluticasone showed greater efficacy in improvement of lung function, especially the patients also having high eosinophil counts.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Blood eosinophil counts have been documented as a good biomarker for patients with chronic obstructive pulmonary disease (COPD) using inhaled corticosteroid (ICS) therapy. However, the effectiveness and safety of prescribing high or medium dose of ICS for patients with different eosinophil counts are unknown.

Methods: A post hoc analysis of a previous prospective randomized study was performed for COPD patients using higher dose (HD: Fluticasone 1,000 &mu;g/day) or medium dose (MD: Fluticasone 500 &mu;g/day) of ICS combined with Salmeterol (100 &mu;g/day). Patients were classified into two groups: those with high eosinophil counts (HE &ge;3%) and those with low eosinophil counts (LE &lt;3%). Lung function was evaluated with forced expiratory volume in 1 second, forced vital capacity, and COPD assessment test. Frequencies of acute exacerbation and pneumonia were also measured.

Results: Two hundred and forty-eight patients were studied and classified into higher eosinophil (HE) (n=85, 34.3%) and lower eosinophil (LE) groups (n=163, 65.7%). The levels of forced expiratory volume in 1 second were significantly increased in patients of HE group treated with HD therapy, compared with the other groups (HE/HD: 125.9&plusmn;27.2 mL vs HE/MD: 94.3&plusmn;23.7 mL, vs LE/HD: 70.4&plusmn;20.5 mL, vs LE/MD: 49.8&plusmn;16.7 mL; P&lt;0.05) at the end of the study. Quality of life (COPD assessment test) markedly improved in HE/HD group than in MD/LE group (HE/HD: 9&plusmn;5 vs LE/MD: 16&plusmn;7, P=0.02). The frequency of acute exacerbation was more decreased in HE/HD group patients, compared with that in LE/MD group (HE/HD: 13.5% vs LE/MD: 28.7%, P&lt;0.01). Pneumonia incidence was similar in the treatment groups (HE/HD: 3.2%, HE/MD: 2.6%, LE/HD: 3.5%, LE/MD 2.8%; P=0.38).

Conclusion: The study results support using blood eosinophil counts as a biomarker of ICS response and show the benefits of greater improvement of lung function, quality of life, and decreased exacerbation frequency in COPD patients with blood eosinophil counts higher than 3%, especially treated with higher dose of ICS.

No MeSH data available.