1Dept. Pulmonology, Semmelweis University, Budapest
Introduction: Patients with COPD exacerbations (COPD-E) and increased blood eosinophil counts can represent a clinical phenotype that may respond better to systemic steroid therapy. However, data from tertiary clinical care, where usually more severe patients are treated, are missing.
Aims: To clinically characterize patients with acute severe COPD-E with and without increased blood eosinophil percentage, who are hospitalized at a university clinic.
Method: We recruited patients hospitalized with COPD-E between 15 February and 15 December 2017 at Dept. Pulmonology, Semmelweis University, Budapest. Patients were free of exacerbation in prior 4 weeks, received max. 1 dose of systemic steroid before blood picture measures on admission. Patients were categorized into eosinophil positive (Eos+: ≥2% of leukocyte, N=33) and negative groups (Eos-: <2% of leukocyte, N=70). All patients were treated with systemic steroids during hospital stay. We analyzed data on medical history, blood C-reactive protein (CRP) concentration, spirometry, sputum culture results.
Results: No difference was found between patients with Eos+ and Eos- COPD-E in age, gender, length of COPD diagnosis, body mass index, pack-years, current smoking status, previous exacerbation history, FEV1 on admission, length of hospital stay and rate of positive bacteriological culture results of sputum. On admission there was a tendency for better FEV1/FVC (forced expiratory volume in the 1st second/forced vital capacity) (Eos+: 0.49 ± 0.09 vs. Eos-: 0.45 ± 0.09, mean ± SD, t-test: p=0.07) and lower CRP value in Eos+ patients (8.4 /2.4-18.9/ vs. 12.4 /4.3-44.5/ mg/L, median /interquartile range/, Mann-Whitney test: p=0.08). The improvement in FEV1 during hospital stay was higher in Eos+ patients (230 /60-600/ mL vs. 70 /-30-203/ mL, p=0.04).
Conclusion: COPD-E requiring hospitalizations and presenting with increased blood eosinophil percentage show a better lung function response to systemic steroid treatment and tend to have lower systemic inflammation. This implies the need for phenotype-specific therapy of COPD exacerbations.
Compulsory conference presentation as a grantee of the New National Excellence Program of the Ministry of Human Capacities (ÚNKP-17-4-III-SE-10).
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