Osman Savran1, Nina Godtfredsen1,2, Torben Sørensen3, Christian Jensen4, Charlotte Suppli Ulrik5,6. 1. Respiratory Research Unit Hvidovre, Department of Respiratory Medicine, Hvidovre Hospital, 2650, Hvidovre, Denmark. 2. Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. 3. Værløse Lægehus, Værløse, Denmark. 4. Lægehuset Remisen, Præstø, Denmark. 5. Respiratory Research Unit Hvidovre, Department of Respiratory Medicine, Hvidovre Hospital, 2650, Hvidovre, Denmark. csulrik@dadlnet.dk. 6. Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. csulrik@dadlnet.dk.
Abstract
BACKGROUND AND OBJECTIVE: Inhaled corticosteroid (ICS) therapy for COPD should be guided by exacerbations and blood-eosinophils according to the GOLD 2020 strategy document. In the present study, we applied these recent recommendations in a large cohort of COPD patients recruited from general practice. METHODS: The participating general practitioners (n = 144) recruited patients with a diagnosis of COPD currently prescribed ICS and reported data on exacerbation history and blood-eosinophils. Clinical variables were compared using two-sample t-tests. RESULTS: The study cohort comprised 1,567 COPD patients (44% males and mean age 72 years). In the past 12 months, 849 (54%) of the COPD patients currently prescribed ICS had no exacerbation, whereas 383 (24%) and 328 (21%) patients, respectively, had a history of one exacerbation and two or more exacerbations. Compared to patients with one or no exacerbation, patients with ≥ 2 exacerbations (21%) per year reported more dyspnea (p < 0.001) and had higher degree of airflow obstruction (p < 0.001). Among patients with no and at least one exacerbation within the preceding 12 months, 30% and 26%, respectively, had a blood-eosinophil count ≥ 0.3 × 109/L. In patients with two or more exacerbations within the last 12 months, 77% had a blood-eosinophil count of ≥ 0.1 × 109/L. Furthermore, 166 patients (11%) had at least one hospital admission due to COPD exacerbation, and a blood-eosinophil count of ≥ 0.1 × 109/L. CONCLUSION: This study of a large cohort of COPD patients currently prescribed inhaled corticosteroids suggests the need for re-evaluating the management strategy to increase benefit and reduce adverse effects of ICS treatment in COPD patients managed in primary care.
BACKGROUND AND OBJECTIVE: Inhaled corticosteroid (ICS) therapy for COPD should be guided by exacerbations and blood-eosinophils according to the GOLD 2020 strategy document. In the present study, we applied these recent recommendations in a large cohort of COPDpatients recruited from general practice. METHODS: The participating general practitioners (n = 144) recruited patients with a diagnosis of COPD currently prescribed ICS and reported data on exacerbation history and blood-eosinophils. Clinical variables were compared using two-sample t-tests. RESULTS: The study cohort comprised 1,567 COPDpatients (44% males and mean age 72 years). In the past 12 months, 849 (54%) of the COPDpatients currently prescribed ICS had no exacerbation, whereas 383 (24%) and 328 (21%) patients, respectively, had a history of one exacerbation and two or more exacerbations. Compared to patients with one or no exacerbation, patients with ≥ 2 exacerbations (21%) per year reported more dyspnea (p < 0.001) and had higher degree of airflow obstruction (p < 0.001). Among patients with no and at least one exacerbation within the preceding 12 months, 30% and 26%, respectively, had a blood-eosinophil count ≥ 0.3 × 109/L. In patients with two or more exacerbations within the last 12 months, 77% had a blood-eosinophil count of ≥ 0.1 × 109/L. Furthermore, 166 patients (11%) had at least one hospital admission due to COPD exacerbation, and a blood-eosinophil count of ≥ 0.1 × 109/L. CONCLUSION: This study of a large cohort of COPDpatients currently prescribed inhaled corticosteroids suggests the need for re-evaluating the management strategy to increase benefit and reduce adverse effects of ICS treatment in COPDpatients managed in primary care.
Entities:
Keywords:
COPD; Eosinophils; Exacerbations; General practice; ICS
Authors: Steven Pascoe; Nicholas Locantore; Mark T Dransfield; Neil C Barnes; Ian D Pavord Journal: Lancet Respir Med Date: 2015-04-12 Impact factor: 30.700
Authors: Salman H Siddiqui; Alessandro Guasconi; Jørgen Vestbo; Paul Jones; Alvar Agusti; Pierluigi Paggiaro; Jadwiga A Wedzicha; Dave Singh Journal: Am J Respir Crit Care Med Date: 2015-08-15 Impact factor: 21.405
Authors: Ciro Casanova; Bartolome R Celli; Juan P de-Torres; Cristina Martínez-Gonzalez; Borja G Cosio; Victor Pinto-Plata; Pilar de Lucas-Ramos; Miguel Divo; Antonia Fuster; Germán Peces-Barba; Myriam Calle-Rubio; Ingrid Solanes; Ramón Aguero; Nuria Feu-Collado; Inmaculada Alfageme; Alfredo De Diego; Amparo Romero; Eva Balcells; Antonia Llunell; Juan B Galdiz; Margarita Marin; Amalia Moreno; Carlos Cabrera; Rafael Golpe; Celia Lacarcel; Joan B Soriano; José Luis López-Campos; Juan J Soler-Cataluña; José M Marin Journal: Eur Respir J Date: 2017-11-22 Impact factor: 16.671
Authors: Henrik Watz; Kay Tetzlaff; Emiel F M Wouters; Anne Kirsten; Helgo Magnussen; Roberto Rodriguez-Roisin; Claus Vogelmeier; Leonardo M Fabbri; Pascal Chanez; Ronald Dahl; Bernd Disse; Helen Finnigan; Peter M A Calverley Journal: Lancet Respir Med Date: 2016-04-07 Impact factor: 30.700
Authors: Gustavo J Rodrigo; David Price; Antonio Anzueto; Dave Singh; Pablo Altman; Giovanni Bader; Francesco Patalano; Robert Fogel; Konstantinos Kostikas Journal: Int J Chron Obstruct Pulmon Dis Date: 2017-03-17
Authors: Mona Bafadhel; Stefan Peterson; Miguel A De Blas; Peter M Calverley; Stephen I Rennard; Kai Richter; Malin Fagerås Journal: Lancet Respir Med Date: 2018-01-10 Impact factor: 30.700
Authors: Ian D Pavord; Sally Lettis; Nicholas Locantore; Steve Pascoe; Paul W Jones; Jadwiga A Wedzicha; Neil C Barnes Journal: Thorax Date: 2015-11-19 Impact factor: 9.139