Journal Club - Stability of Blood EOS as COPD phenotype prediction

Location: 

Calgary, Alberta

Date: 

Sep 24, 2019

Discussion topic and resource: Stability of the Blood Eosinophilic Phenotype in Stable and Exacerbated COPD.

Reference:  Desiree M. Schumann, PhD; Michael Tamm, MD, PhD; Kostantinos Kostikas; MD; and Diana Stolz, MD, MPH, FCCP.
Original Research COPD, American college of Chest Physicians. Published by Elsivier Inc. 2019
DOI: https://doi.org/10.1016/j.chest.2019.04.012

Lead by:  Dr. Tourin
Duration: 30 minutes
Discussion: The controversy regarding the use of blood eosinophil levels as a biomarker of exacerbation risk and responsiveness of patients to inhaled corticosteroids (ICS).

Patients in stable COPD with Gold Initiative for Chronic Obstructive Lung Disease airflow obstruction grades 2 to 4 were enrolled in an observational multicenter trial. Concordance was defined as blood eosinophil levels persistently lower than or persistently higher than the absolute cutoffs of 150 cells/uL and 300 cells/uL, or the percentage of cutoff points of 2%, 3% and 4%. Discordance was obtained when the blood eosinophil values varied between any two visits. ICS treatment data were recorded at one time point at the inclusion of the study.

Conclusion:  Patients in a stable state had higher discordant values than patients with mild/moderate exacerbations. The same was seen in patients hospitalized for other illnesses compared with patients hospitalized for severe exacerbation of COPD. Discordancy was high regardless of whether patients were taking ICS at the beginning of the study period.