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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.


Related in: MedlinePlus

Quality of life improvement with CAT scores in HE and LE patients using HD and MD therapy.Abbreviations: CAT, COPD assessment test; HD, high dose; HE, higher eosinophil count; LE, lower eosinophil; MD, medium dose.
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f4-copd-11-2341: Quality of life improvement with CAT scores in HE and LE patients using HD and MD therapy.Abbreviations: CAT, COPD assessment test; HD, high dose; HE, higher eosinophil count; LE, lower eosinophil; MD, medium dose.

Mentions: Patient-assessed COPD symptoms scores with CAT questionnaire decreased in both HE and LE groups, with a statistically significant difference found in favor of the patients treated in the HD group. The CAT scores were as follows: HE/HD: 9±5, HE/MD: 12±6, LE/HD: 13±5, and LE/MD: 16±7 throughout the study (Figure 4). There was a trend of a higher quality of life among the patients who received continuous treatment with higher dose of ICS, especially in patients with accompanying high eosinophil counts, and statistically more significant difference in CAT scores among patients treated with medium ICS dose, even in those with high eosinophil counts (LE/HD). Average changes from baseline in the mean scores of CAT decrease also showed significant differences between HE patients and LE patients (8±3 vs 4±2, P=0.04) at the end of study, irrespective of whether the patients were treated with HD or MD therapy. There was greater benefit and more treatment response, especially in HE patients using ICS therapy.


Effectiveness using higher inhaled corticosteroid dosage in patients with COPD by different blood eosinophilic counts
Quality of life improvement with CAT scores in HE and LE patients using HD and MD therapy.Abbreviations: CAT, COPD assessment test; HD, high dose; HE, higher eosinophil count; LE, lower eosinophil; MD, medium dose.
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC5036601&req=5

f4-copd-11-2341: Quality of life improvement with CAT scores in HE and LE patients using HD and MD therapy.Abbreviations: CAT, COPD assessment test; HD, high dose; HE, higher eosinophil count; LE, lower eosinophil; MD, medium dose.
Mentions: Patient-assessed COPD symptoms scores with CAT questionnaire decreased in both HE and LE groups, with a statistically significant difference found in favor of the patients treated in the HD group. The CAT scores were as follows: HE/HD: 9±5, HE/MD: 12±6, LE/HD: 13±5, and LE/MD: 16±7 throughout the study (Figure 4). There was a trend of a higher quality of life among the patients who received continuous treatment with higher dose of ICS, especially in patients with accompanying high eosinophil counts, and statistically more significant difference in CAT scores among patients treated with medium ICS dose, even in those with high eosinophil counts (LE/HD). Average changes from baseline in the mean scores of CAT decrease also showed significant differences between HE patients and LE patients (8±3 vs 4±2, P=0.04) at the end of study, irrespective of whether the patients were treated with HD or MD therapy. There was greater benefit and more treatment response, especially in HE patients using ICS therapy.

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.


Related in: MedlinePlus