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Eosinophilic airway inflammation and exacerbations of COPD: a randomised controlled trial

R. Siva, R. H. Green, C. E. Brightling, M. Shelley, B. Hargadon, S. McKenna, W. Monteiro, M. Berry, D. Parker, A. J. Wardlaw, I. D. Pavord
European Respiratory Journal 2007 29: 906-913; DOI: 10.1183/09031936.00146306
R. Siva
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R. H. Green
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C. E. Brightling
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M. Shelley
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B. Hargadon
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S. McKenna
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W. Monteiro
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M. Berry
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D. Parker
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A. J. Wardlaw
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I. D. Pavord
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Figures

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  • Fig. 1—
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    Fig. 1—

    Flow chart of the trial profile. COPD: chronic obstructive pulmonary disease; BTS: British Thoracic Society.

  • Fig. 2—
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    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—
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    Fig. 3—

    Hospital admissions in the British Thoracic Society (□) and sputum (•) groups. p = 0.037.

  • Fig. 4—
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    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

  • Figures
  • Table 1—

    Treatment algorithm

    SymptomsSputum eosinophils
    <1%1–3%>3%
    ImprovedDecrease bronchodilatorDecrease bronchodilatorDecrease bronchodilator
    Decrease anti-inflammatoryNo change in anti-inflammatoryIncrease anti-inflammatory
    No changeNo change in bronchodilatorNo change in bronchodilatorNo change in bronchodilator
    Decrease anti-inflammatoryNo change in anti-inflammatoryIncrease anti-inflammatory
    WorseIncrease bronchodilatorIncrease bronchodilatorIncrease bronchodilator
    Decrease anti-inflammatoryNo change in anti-inflammatoryIncrease anti-inflammatory
  • Table 2—

    Hierarchy of bronchodilator and anti-inflammatory treatment

    BronchodilatorAnti-inflammatory
    No treatmentNo treatment
    Short-acting β-agonist, as requiredICS <400 μg
    Regular short-acting anticholinergicICS <800 μg
    Long-acting β-agonistICS <2000 μg
    Long-acting anticholinergicPrednisolone 5 mg daily
    TheophyllinePrednisolone 10 mg daily
    Nebuliser trialPrednisolone 30 mg daily
    • ICS: inhaled corticosteroids. ICS doses are beclomethasone equivalents·day−1.

  • Table 3—

    Patient demographics

    BTS groupSputum group
    Subjects n4042
    Age yrs70 (49–80)68 (45–82)
    Male/female30/1025/17
    Smoking n
     Current smoker812
     Ex-smoker3130
     Never-smoker10
    Smoking pack-yrs47.5±27.850.6±30.0
    FEV1 L1.07±0.440.96±0.47
    FVC L2.28±0.842.11±0.67
    Post-bronchodilator FEV1 L1.14±0.481.04±0.50
    FEV1 % pred38.4±15.538.1±15.4
    TLC % pred98.6±15.399.7±15.4
    RV % pred123.6±38.1133.1±47.1
    KCO % pred75.0±17.965.5±22.9
    BMI26.1±3.526.0±0.2
    Baseline sputum eosinophil %#1.5±0.61.7±0.6
    Blood eosinophils ×109·L−10.24±0.240.20±0.15
    Exhaled nitric oxide ppb5.3±6.57.6±8.9
    Serum IgE#61.6±0.736.3±0.7
    Baseline inhaled steroid dose¶1200±1007.61024±902.2
    Patients admitted in previous year n1212
    Rate of admission in previous year0.55±0.70.43±0.6
    Attended pulmonary rehab within 1-yr prior to study n109
    • 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.

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Vol 29 Issue 5 Table of Contents
European Respiratory Journal: 29 (5)
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Eosinophilic airway inflammation and exacerbations of COPD: a randomised controlled trial
R. Siva, R. H. Green, C. E. Brightling, M. Shelley, B. Hargadon, S. McKenna, W. Monteiro, M. Berry, D. Parker, A. J. Wardlaw, I. D. Pavord
European Respiratory Journal May 2007, 29 (5) 906-913; DOI: 10.1183/09031936.00146306

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Eosinophilic airway inflammation and exacerbations of COPD: a randomised controlled trial
R. Siva, R. H. Green, C. E. Brightling, M. Shelley, B. Hargadon, S. McKenna, W. Monteiro, M. Berry, D. Parker, A. J. Wardlaw, I. D. Pavord
European Respiratory Journal May 2007, 29 (5) 906-913; DOI: 10.1183/09031936.00146306
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