Figures
- Fig. 1—
Flow chart of the trial profile. COPD: chronic obstructive pulmonary disease; BTS: British Thoracic Society.
- Fig. 2—
Sputum eosinophil counts per month for a) all patients and b) patients with baseline sputum eosinophil count >3%. The whiskers represent sem. □: British Thoracic Society group; •: sputum group.
- Fig. 3—
Hospital admissions in the British Thoracic Society (□) and sputum (•) groups. p = 0.037.
- Fig. 4—
a) Symptom scores, b) quality-of-life scores and c) post-bronchodilator forced expiratory volume in one second (FEV1) for the British Thoracic Society (□) and sputum (•) groups. The whiskers represent sem. VAS: visual analogue scores.
Tables
- Table 1—
Treatment algorithm
Symptoms Sputum eosinophils <1% 1–3% >3% Improved Decrease bronchodilator Decrease bronchodilator Decrease bronchodilator Decrease anti-inflammatory No change in anti-inflammatory Increase anti-inflammatory No change No change in bronchodilator No change in bronchodilator No change in bronchodilator Decrease anti-inflammatory No change in anti-inflammatory Increase anti-inflammatory Worse Increase bronchodilator Increase bronchodilator Increase bronchodilator Decrease anti-inflammatory No change in anti-inflammatory Increase anti-inflammatory - Table 2—
Hierarchy of bronchodilator and anti-inflammatory treatment
Bronchodilator Anti-inflammatory No treatment No treatment Short-acting β-agonist, as required ICS <400 μg Regular short-acting anticholinergic ICS <800 μg Long-acting β-agonist ICS <2000 μg Long-acting anticholinergic Prednisolone 5 mg daily Theophylline Prednisolone 10 mg daily Nebuliser trial Prednisolone 30 mg daily ICS: inhaled corticosteroids. ICS doses are beclomethasone equivalents·day−1.
- Table 3—
Patient demographics
BTS group Sputum group Subjects n 40 42 Age yrs 70 (49–80) 68 (45–82) Male/female 30/10 25/17 Smoking n Current smoker 8 12 Ex-smoker 31 30 Never-smoker 1 0 Smoking pack-yrs 47.5±27.8 50.6±30.0 FEV1 L 1.07±0.44 0.96±0.47 FVC L 2.28±0.84 2.11±0.67 Post-bronchodilator FEV1 L 1.14±0.48 1.04±0.50 FEV1 % pred 38.4±15.5 38.1±15.4 TLC % pred 98.6±15.3 99.7±15.4 RV % pred 123.6±38.1 133.1±47.1 KCO % pred 75.0±17.9 65.5±22.9 BMI 26.1±3.5 26.0±0.2 Baseline sputum eosinophil %# 1.5±0.6 1.7±0.6 Blood eosinophils ×109·L−1 0.24±0.24 0.20±0.15 Exhaled nitric oxide ppb 5.3±6.5 7.6±8.9 Serum IgE# 61.6±0.7 36.3±0.7 Baseline inhaled steroid dose¶ 1200±1007.6 1024±902.2 Patients admitted in previous year n 12 12 Rate of admission in previous year 0.55±0.7 0.43±0.6 Attended pulmonary rehab within 1-yr prior to study n 10 9 Data are presented as mean (range) or mean±sd, unless otherwise stated. BTS: British Thoracic Society; FEV1: forced expiratory volume in one second; FVC: forced vital capacity; % pred: % predicted; TLC: total lung capacity; RV: residual volume; KCO: corrected gas transfer; BMI: body mass index; Ig: immunoglobulin. #: Geometric mean; ¶: beclomethasone diproprionate equivalent μg·day−1.
