Abstract
Background Guidelines advocate oral steroids and antibiotics to treat COPD exacerbations but therapy is not always effective. The blood eosinophil count has identified patients that respond to steroids but whether these findings can be replicated in a larger population including hospitalised exacerbations remains unclear.
Methods Analysis of randomised clinical studies comparing treatment failure outcomes in COPD exacerbations treated with prednisolone or placebo/equivalent stratified by the blood eosinophil count was performed. Treatment failure was defined as re-treatment, hospitalisation or death within 90 days of randomisation.
Results 3 RCT's (Davies Lancet 1999;Bafadhel AJRCCM 2012;Aaron Thorax 2013) had blood eosinophil count data available in 243 subjects (160 M, mean age 67 years) from 300 exacerbations; 45% were associated with a blood eosinophil count ≥2%. In total there were 68 treatment failures (23%). The treatment failure rate was 66% in patients with a blood eosinophil count ≥2% who did not receive prednisolone and 11% in those that did (mean difference 55%; 95%CI of difference 38 to 73%; P<0.001). There was no significant difference in outcome in patients with a blood eosinophil count <2%.
Conclusion Heterogeneity in response to prednisolone during an exacerbation can be minimised using the eosinophil count as a biomarker to direct therapy. Definitive studies are urgently needed.
- © 2014 ERS