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Correspondence |

Eosinophils and COPD Readmission FREE TO VIEW

Lorraine Thong, MB; Michael O’Driscoll, MB; Carmel Casey, BSc; Marcus Kennedy, MB, FCCP; Barry J. Plant, MB; Michael T. Henry, MB; Desmond M. Murphy, MB, FCCP
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following: B. J. P. has received speaker and consultancy fees from Novartis, Gilead, Pfizer, Menarini, Vertex, GlaxoSmithKline, and Rapport Pharmaceuticals. D. M. M. is the past recipient of an European Respiratory Society fellowship and has received grants for research from University College Cork. He has received fees for consultancy work from Novartis, Bayer, AstraZeneca, Menarini, Nycomed, Gillead, Boehringer-Ingelheim, and Mundipharma; he has received speaker’s fees from Pfizer, Menarini, GlaxoSmithKline, Bayer, MSD, and Novartis; and he has traveled to international symposia as a guest of Boehringer-Ingelheim and Novartis. He has no conflict of interest related to the contents of this article. None declared (L. T., M. O. D., C. C. M. K., M. T. H.)

Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland

CORRESPONDENCE TO: Desmond M. Murphy, MB, FCCP, The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland


Copyright 2017, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(3):724-725. doi:10.1016/j.chest.2016.10.065
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We read with interest the recent article from Bafadhel et al published in CHEST (August 2016) and the more recent article from Couillard et al (published in CHEST October 2016) examining the possible role of eosinophils as markers of disease severity and clinical outcome in exacerbations of COPD. The report by Bafadhel et al suggests that patients presenting to a hospital with an eosinophilic exacerbation of COPD had a shorter length of stay. However, in this study, the authors also reported that readmission rates at 1 year were similar in eosinophilic and noneosinophilic exacerbations. The subsequent study by Couillard et al suggests that eosinophilia was associated with an increased risk of 12-month COPD related readmission.

We recently performed a retrospective study examining 97 patients (21 with an eosinophil count > 0.4 IU/L) enrolled in our COPD outreach program. Patients were stratified into three categories: readmission within 30 days (n = 23), readmission after 30 days (n = 21), and no readmission within 12 months (n = 53). The data were analyzed by using three different thresholds for blood eosinophil count: 0.2, 0.3, and 0.4 IU/L. We found no significant difference in mean eosinophil count among the three groups. Furthermore, there was no significant difference between patients requiring readmission vs those who did not regardless of the threshold of eosinophil count used in the analysis.

All patients accepted into the COPD outreach program at our institution receive standardized doses of oral corticosteroids (prednisolone 40 mg once daily for 5 days) and a 7-day course of oral antibiotics when indicated. Current interest has focused on an eosinophilic phenotype of COPD as a more treatment-responsive group. Conversely, other studies suggest that this phenotype may be more prone to exacerbation. Bafadhel et al previously published data suggesting that duration of steroid therapy in exacerbations could be modified in patients with an eosinophilic exacerbation. Our data suggest that with standardized therapy, this group performs no better or worse than patients with noneosinophilic exacerbations. These data taken together suggest that current COPD outreach treatment protocols may result in overtreatment of eosinophilic exacerbations of COPD without any additional benefits. The study by Couillard et al provides different results.

These 2 studies and the additional study from our institution suggest that the role of the eosinophil as a reliable, consistent marker of clinical outcome in COPD has yet to be fully defined.

References

Bafadhel M. .Greening N.J. .Harvey-Dunstan T.C. .et al Blood eosinophils and outcomes in severe hospitalized exacerbations of COPD. Chest. 2016;150:320-328 [PubMed]journal. [CrossRef] [PubMed]
 
Couillard S. .Larivée P. .Courteau J. .Vanasse A. . Eosinophils in COPD exacerbations are associated with increased readmissions. Chest. 2017;151:366-373 [PubMed]journal. [CrossRef] [PubMed]
 
Barnes N.C. .Sharma R. .Lettis S. .Calverley P.M. . Blood eosinophils as a marker of response to inhaled corticosteroids in COPD. Eur Respir J. 2016;47:1374-1382 [PubMed]journal. [CrossRef] [PubMed]
 
Vedel-Krogh S. .Nielsen S.F. .Lange P. .Vestbo J. .Nordestgaard B.G. . Blood eosinophils and exacerbations in chronic obstructive pulmonary disease. The Copenhagen General Population Study. Am J Respir Crit Care Med. 2016;193:965-974 [PubMed]journal. [CrossRef] [PubMed]
 
Bafadhel M. .McKenna S. .Terry S. .et al Blood eosinophils to direct corticosteroid treatment of exacerbations of chronic obstructive pulmonary disease: a randomized placebo-controlled trial. Am J Respir Crit Care Med. 2012;186:48-55 [PubMed]journal. [CrossRef] [PubMed]
 

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References

Bafadhel M. .Greening N.J. .Harvey-Dunstan T.C. .et al Blood eosinophils and outcomes in severe hospitalized exacerbations of COPD. Chest. 2016;150:320-328 [PubMed]journal. [CrossRef] [PubMed]
 
Couillard S. .Larivée P. .Courteau J. .Vanasse A. . Eosinophils in COPD exacerbations are associated with increased readmissions. Chest. 2017;151:366-373 [PubMed]journal. [CrossRef] [PubMed]
 
Barnes N.C. .Sharma R. .Lettis S. .Calverley P.M. . Blood eosinophils as a marker of response to inhaled corticosteroids in COPD. Eur Respir J. 2016;47:1374-1382 [PubMed]journal. [CrossRef] [PubMed]
 
Vedel-Krogh S. .Nielsen S.F. .Lange P. .Vestbo J. .Nordestgaard B.G. . Blood eosinophils and exacerbations in chronic obstructive pulmonary disease. The Copenhagen General Population Study. Am J Respir Crit Care Med. 2016;193:965-974 [PubMed]journal. [CrossRef] [PubMed]
 
Bafadhel M. .McKenna S. .Terry S. .et al Blood eosinophils to direct corticosteroid treatment of exacerbations of chronic obstructive pulmonary disease: a randomized placebo-controlled trial. Am J Respir Crit Care Med. 2012;186:48-55 [PubMed]journal. [CrossRef] [PubMed]
 
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