COPD patients prescribed inhaled corticosteroid in primary care: time for re-assessment based on exacerbation rate and blood eosinophils?

Respiratory Research

Christian Jensen¹  Osman Savran²  Nina Godtfredsen³  Charlotte Suppli Ulrik³  Torben Sørensen⁴ 

[1] Lægehuset Remisen, Præstø, Denmark;Respiratory Research Unit Hvidovre, Department of Respiratory Medicine, Hvidovre Hospital, 2650, Hvidovre, Denmark;Respiratory Research Unit Hvidovre, Department of Respiratory Medicine, Hvidovre Hospital, 2650, Hvidovre, Denmark;Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark;Værløse Lægehus, Værløse, Denmark;

关键词: COPD;    ICS;    General practice;    Exacerbations;    Eosinophils;   

DOI  :  10.1186/s12931-021-01651-w

来源: Springer

【 摘 要 】

Background and objectiveInhaled 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.MethodsThe 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.ResultsThe 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.ConclusionThis 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.

【 授权许可】

CC BY