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Persistent Eosinophilia Is Associated with Increased Chronic Obstructive Pulmonary Disease Exacerbations
Description
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A3129 - Persistent Eosinophilia Is Associated with Increased Chronic Obstructive Pulmonary Disease Exacerbations
Author Block: W. Cheung, G. Hamad, M. G. Crooks, A. H. Morice; Respiratory Medicine, Castle Hill Hospital, Cottingham, United Kingdom.
Rationale
In Chronic Obstructive Pulmonary Disease (COPD) eosinophilia has been suggested as a biomarker for inhaled corticosteroid responsiveness, and has been associated with increased exacerbations. However, the majority of current literature has focused on an eosinophil estimation taken at a single time point. With the known variability in eosinophil levels, single eosinophil estimation may not reflect overall eosinophilia. We hypothesized that multiple eosinophil counts will be a better reflection of true eosinophilia and therefore higher risk of exacerbations.
Methods
Demographics, spirometry, number of exacerbations within 12 months and five full blood counts were retrospectively collected from COPD patients in the Hull and East Riding area as part of an ongoing audit to assess prescribing compliance in COPD. Exacerbations were defined as: 1) oral steroid prescription or 2) oral antibiotic prescription for COPD. Eosinophilia was defined as ≥0.30x10^9 cells/L. More than four eosinophilic counts were “persistent”, one to three eosinophilic counts was “intermittent” and zero was non-eosinophilic. A quasi-poisson regression model with 40 multiply imputed datasets was used adjusted for age, gender, predicted FEV1, MRC dyspnoea scale, smoking status and asthma.
Results
Data was collected for 611 patients (280 male) from four general practices, of which 253 have an asthma co-diagnosis. Patients had a median age of 68 (IQR 60-76) with a predicted FEV1 62 (46-75). Greater than 95 percent (581/611) had one eosinophil count and 54.5% (333/611) had five eosinophil counts.
Using only the most recent eosinophil count, there was no statistically significant association with oral steroid and antibiotic prescription rate ratio (RR) 1.15 (95% CI 0.79-1.68, p=0.46) and 1.16 (0.89-1.52, p=0.28) respectively. Intermittent eosinophilia did not have a statistically significant association with oral steroid prescriptions RR 1.41 (0.90-2.21, p=0.13). Persistent eosinophilia RR 2.52 (1.57-4.02, p=0.0001) was found to be associated with increased oral steroid prescriptions. Intermittent eosinophilia RR 1.34 (1.00-1.78, p=0.050) and persistent eosinophilia RR 1.58 (1.10-2.28, p=0.014) were both associated with increased antibiotic prescriptions.
Eosinophilia on a single measurement was not associated with increased COPD exacerbations. Persistent eosinophilia was associated with increased exacerbations in our cohort. The difference seen between a single eosinophil count and persistence of eosinophilia may explain the conflicting results seen in the literature.
Conclusion
Due to the variability of blood eosinophils, single estimations should not be used to determine a patients eosinophilic status. Multiple eosinophil counts should be employed in future research regarding eosinophilia in COPD.
Author Block: W. Cheung, G. Hamad, M. G. Crooks, A. H. Morice; Respiratory Medicine, Castle Hill Hospital, Cottingham, United Kingdom.
Rationale
In Chronic Obstructive Pulmonary Disease (COPD) eosinophilia has been suggested as a biomarker for inhaled corticosteroid responsiveness, and has been associated with increased exacerbations. However, the majority of current literature has focused on an eosinophil estimation taken at a single time point. With the known variability in eosinophil levels, single eosinophil estimation may not reflect overall eosinophilia. We hypothesized that multiple eosinophil counts will be a better reflection of true eosinophilia and therefore higher risk of exacerbations.
Methods
Demographics, spirometry, number of exacerbations within 12 months and five full blood counts were retrospectively collected from COPD patients in the Hull and East Riding area as part of an ongoing audit to assess prescribing compliance in COPD. Exacerbations were defined as: 1) oral steroid prescription or 2) oral antibiotic prescription for COPD. Eosinophilia was defined as ≥0.30x10^9 cells/L. More than four eosinophilic counts were “persistent”, one to three eosinophilic counts was “intermittent” and zero was non-eosinophilic. A quasi-poisson regression model with 40 multiply imputed datasets was used adjusted for age, gender, predicted FEV1, MRC dyspnoea scale, smoking status and asthma.
Results
Data was collected for 611 patients (280 male) from four general practices, of which 253 have an asthma co-diagnosis. Patients had a median age of 68 (IQR 60-76) with a predicted FEV1 62 (46-75). Greater than 95 percent (581/611) had one eosinophil count and 54.5% (333/611) had five eosinophil counts.
Using only the most recent eosinophil count, there was no statistically significant association with oral steroid and antibiotic prescription rate ratio (RR) 1.15 (95% CI 0.79-1.68, p=0.46) and 1.16 (0.89-1.52, p=0.28) respectively. Intermittent eosinophilia did not have a statistically significant association with oral steroid prescriptions RR 1.41 (0.90-2.21, p=0.13). Persistent eosinophilia RR 2.52 (1.57-4.02, p=0.0001) was found to be associated with increased oral steroid prescriptions. Intermittent eosinophilia RR 1.34 (1.00-1.78, p=0.050) and persistent eosinophilia RR 1.58 (1.10-2.28, p=0.014) were both associated with increased antibiotic prescriptions.
Eosinophilia on a single measurement was not associated with increased COPD exacerbations. Persistent eosinophilia was associated with increased exacerbations in our cohort. The difference seen between a single eosinophil count and persistence of eosinophilia may explain the conflicting results seen in the literature.
Conclusion
Due to the variability of blood eosinophils, single estimations should not be used to determine a patients eosinophilic status. Multiple eosinophil counts should be employed in future research regarding eosinophilia in COPD.
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