TY - JOUR T1 - Sputum eosinophilia identifies systemic corticosteroid responsiveness in acute exacerbations of COPD JF - European Respiratory Journal JO - Eur Respir J VL - 38 IS - Suppl 55 SP - 354 AU - Mona Bafadhel AU - Susan McKenna AU - Sarah Terry AU - Vijay Mistry AU - Mitesh Pancholi AU - David Lomas AU - Per Venge AU - Mike Barer AU - Seb Johnston AU - Ian Pavord AU - Chris Brightling Y1 - 2011/09/01 UR - http://erj.ersjournals.com/content/38/Suppl_55/354.abstract N2 - Introduction: Eosinophilic airway inflammation (EA, >3% sputum eosinophils) during stable chronic obstructive pulmonary disease is associated with corticosteroid responsiveness. Whether this is true during exacerbations remains unknown.Methods: COPD patients were entered into a double blind prednisolone placebo controlled trial. Measurements of airway inflammation, lung function and health status using the chronic respiratory questionnaire (CRQ) and visual analogue scale (VAS) were assessed at baseline, exacerbation and 2 weeks after treatment.Results: 166 exacerbations were captured from 109 patients (69 men, 40 women). All eosinophilic exacerbations (n=31) were treated with prednisolone. Non eosinophilic airway inflammation (NEA) occurred in 135 exacerbations, of which 70% (n=94) were treated with prednisolone and 30% (n=41) with placebo. Two weeks after prednisolone treated exacerbations, quality of life and lung function improved significantly in those with EA compared to NEA (mean change, 95%CI) in CRQ and FEV1 was 1.5 units (1.1 to 1.9) vs. 0.8 units (0.5 to 1.0) (p<0.001) and 335mL (219 to 451) vs. 102mL (52 to 152) (p<0.001) respectively. VAS returned to baseline earlier in EA exacerbations treated with prednisolone (p=0.016, see figure)Conclusion: Corticosteroid responsiveness during exacerbations of COPD can be identified by a sputum eosinophilia. ER -