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Eur Respir J 2007, doi:10.1183/09031936.00146306
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ORIGINAL ARTICLE |
Eosinophilic airway inflammation and exacerbations of COPD: a randomised controlled trial
1 Institute for Lung Health, Dept of Respiratory Medicine and Thoracic Surgery, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
* To whom correspondence should be addressed. E-mail: ian.pavord{at}uhl-tr.nhs.uk.
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Abstract |
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Evidence suggests that eosinophilic airway inflammation is important in the pathogenesis of severe COPD exacerbations. We have tested the hypothesis that a management strategy which aims to reduce sputum eosinophil counts is associated with a reduction in exacerbations of COPD.
82 patients with COPD were randomised into two groups. One group was treated according to traditional guidelines (BTS group), and the other with the additional aim of minimising eosinophilic airway inflammation, assessed using the induced sputum eosinophil count (sputum group). Primary outcome was exacerbations categorised as mild, moderate, or severe.
The frequency of severe exacerbations/patient/year was 0.5 in the BTS group and 0.2 in the sputum group (mean reduction 62%, p=0.037). Most benefit was confined to patients with eosinophilic airway inflammation. There was no difference in the frequency of mild and moderate exacerbations. The average daily dose of inhaled or oral corticosteroid during the trial did not differ between the groups. Out of 42 patients in the sputum group, 17 required regular oral corticosteroids to minimise eosinophilic airway inflammation.
A management strategy that aims to minimise eosinophilic airway inflammation as well as symptoms is associated with a reduction in severe exacerbations of COPD.
Keywords: Airway inflammation, chronic obstructive pulmonary disease, corticosteroids, eosinophils, exacerbations
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