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Rationale. Blood eosinophilia has been shown to be associated with a significant proportion COPD exacerbations and stratifies the clinical response to systemic corticosteroids. The study was a randomised, double-blind, parallel group trial that compared 48 treatment with extrafine beclomethasone dipropionate plus formoterol fumarate (BDP/FF) vs. FF, in severe COPD patients with a history of exacerbations. Objectives. We that there would be treatment differences in response to BDP/FF when by baseline blood eosinophil count in a post hoc analysis. Methods. The patients (N=1, 184) were stratified into four quartile groups based on the baseline eosinophil count and on exacerbation rate, change in pre dose FEV1 and St. George’s Respiratory SGRQ total score over 48 weeks were performed across these. A predictive of future exacerbations was developed based upon baseline blood eosinophil count and factors. Results. The adjusted treatment difference over 48 weeks between the BDP/FF FF groups was largest within the highest baseline blood eosinophil quartile (≥279. 8/µl /µl). Within this quartile a significant (i) 46% reduction in exacerbation rate, (ii) 0. 102 L in pre bronchodilator FEV1 and (iii) 5. 9 units improvement in SGRQ total score seen in favour of BDP/FF. Predictive modelling suggested that the risk of exacerbations influenced by baseline blood eosinophils in patients treated with FF alone, but not in treated with BDP/FF. Conclusions. The presence of a significant blood eosinophilia to be associated with a particularly favorable response to ICS/LABA therapy in COPD.
Siddiqui et al. (Sat,) studied this question.