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Comparison of Clinical Characteristics and Treatment Outcomes Between Eosinophilic and Neutrophilic Exacerbations of COPD Requiring Hospital Admission FREE TO VIEW

Hye Seon Kang, MD; Sang Hoon Jeon, MD; Chin Kook Rhee, DrPH; Sang Haak Lee, DrPH; Yong Hyun Kim, MD
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The Catholic University of Korea School of Medicine, Seoul, Korea (the Republic of)

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):875A. doi:10.1016/j.chest.2016.08.975
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: We aimed to compare the clinical characteristics and treatment outcomes in patients with eosinophilic and neutrophilic chronic obstructive pulmonary disease (COPD) exacerbations requiring hospital admission.

METHODS: This was a retrospective and multicenter study between Jan 2010 and Dec 2014. In all, 729 COPD patients with severe COPD exacerbations requiring hospital admission were enrolled in the study via the outpatient clinics or emergency department at 6 university hospitals. Patients were grouped according to the complete blood count: eosinophilic group, >2% peripheral blood eosinophil; neutrophilic group, >65% peripheral blood neutrophil or >10,000 leukocytes. Patients with radiographic evidence of pneumonia, those having lung cancers or admitted due to other medical problems were excluded.

RESULTS: A total of 729 patients hospitalized with COPD exacerbations were included. There were 207 eosinophilic and 294 neutrophilic COPD exacerbations. In blood gas analysis at admission, pH (7.43±0.80 vs. 7.41±0.56, P=0.031) was lower in eosinophilic COPD patients, but the level of carbon dioxide (43.68±15.84 vs. 42.46±8.98, P=0.024) was higher in patients with neutrophilic COPD. There were no significant differences in pulmonary function tests except lower FEV1 (44.55±15.40 vs. 50.13±21.63, P=0.044) in neutrophilic COPD. There were no significant differences in the duration of hospital stay and treatment outcomes including mortality, but the admission rate of intensive care unit was higher in neutrophilic COPD patients (11.6% vs. 1.8%, P=0.018).

CONCLUSIONS: COPD patients with neutrophilic exacerbations had worse clinical outcomes than those with eosinophilic exacerbations. The peripheral blood eosinophil count could be suggested as a useful marker to predict clinical progress in COPD patients with acute exacerbation during hospitalization.

CLINICAL IMPLICATIONS: Our study supports the theory that peripheral eosinophilia is associated with noninfectious exacerbations, and are useful biomarkers to decide treatment strategies including steroid therapy in COPD patients with exacerbations. Prospective studies are needed to clarify the utility of peripheral eosinophilia in the classification of COPD pnehotypes and individualization of treatment.

DISCLOSURE: The following authors have nothing to disclose: Hye Seon Kang, Sang Hoon Jeon, Chin Kook Rhee, Sang Haak Lee, Yong Hyun Kim

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