Eosinophilia and predicting response to inhaled corticosteroids in chronic obstructive pulmonary disease
Abstract
Chronic obstructive pulmonary disease (COPD) and acute exacerbations of COPD (AE-COPD) are a growing healthcare problem worldwide. Various biomarkers have been studied to optimize therapy in preventing AE-COPD.
In a meta-analysis of the INSPIRE, TRISTAN and SCO30002 studies, administration of inhaled corticosteroids (ICSs) in combination with long-acting beta agonists reduced AE-COPD in patients with blood eosinophilia as compared to placebo or tiotropium. However, these results were not confirmed by either a re-analysis of the ISOLDE study or the FLAME trial.
The SPIROMICS study results favoured sputum eosinophilia for predicting AE COPD. Sputum eosinophilia is also a good predictor of treatment response to ICSs.
Fraction of exhaled nitric oxide (FeNO) is good for predicting ICS responsiveness, but its relationship with prediction of AE-COPD is unclear. High inter- and intra-individual variability of FeNO measurements seems to be another problem.
The relationship of periostin, known to predict good ICS responsiveness, to AE-COPD predictions is also unclear.