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Eosinophilic inflammation in COPD: prevalence and clinical characteristics

Dave Singh, Umme Kolsum, Chris E. Brightling, Nicholas Locantore, Alvar Agusti, Ruth Tal-Singer on behalf of the ECLIPSE investigators
European Respiratory Journal 2014 44: 1697-1700; DOI: 10.1183/09031936.00162414
Dave Singh
1University of Manchester, Medicines Evaluation Unit, University Hospital of South Manchester Foundation Trust, Manchester, UK
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Umme Kolsum
1University of Manchester, Medicines Evaluation Unit, University Hospital of South Manchester Foundation Trust, Manchester, UK
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  • For correspondence: ukolsum@meu.org.uk
Chris E. Brightling
2Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
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Nicholas Locantore
3GlaxoSmithKline, Research and Development, Research Triangle Park, NC, USA
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Alvar Agusti
4Fundació Investigació Sanitària Illes Balears (FISIB), Centro de investigación biomedical en red de enfermedades respiratorias (CIBERES), Palma de Mallorca, Spain
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Ruth Tal-Singer
5GlaxoSmithKline, Research and Development, King of Prussia, PA, USA
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To the Editor:

Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition, with patients displaying varying clinical and pathophysiological features. The identification of COPD phenotypes with distinct characteristics may allow targeted treatment strategies directed towards specific biological pathways.

Eosinophilic inflammation is thought to be a characteristic feature of asthma rather than COPD. However, studies have shown that a subset of COPD patients with eosinophilic airway inflammation exists, even after the careful exclusion of patients with any features of asthma, such as β-agonist reversibility, bronchial hyperresponsiveness, atopy or a childhood history of asthma [1–4]. Interestingly, these patients exhibit the greatest response to corticosteroid treatment [1–4]. Likewise, sputum eosinophil numbers are increased in a subset of COPD exacerbations [5, 6], and titrating corticosteroid therapy according to sputum eosinophil counts reduces exacerbation rates [7]. Furthermore, there are similar increases in sputum and blood eosinophil numbers during COPD exacerbations [5]; using blood eosinophils as a surrogate maker for airway eosinophils to direct oral corticosteroid therapy for the treatment of COPD exacerbations enhances clinical recovery [8]. Taken together, these observations suggest that eosinophilic airway inflammation in COPD is a predictive biomarker of corticosteroid responsiveness during clinical stability and exacerbations.

The prevalence of eosinophilic inflammation in COPD patients is unknown. We do not know whether patients with sputum or blood eosinophilia represent a stable COPD phenotype over time and, apart from corticosteroid responsiveness, little is known about the other clinical characteristics of this subset of patients.

We analysed samples from the ECLIPSE (Evaluation of COPD Longitudinally to Identify …

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European Respiratory Journal: 44 (6)
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Eosinophilic inflammation in COPD: prevalence and clinical characteristics
Dave Singh, Umme Kolsum, Chris E. Brightling, Nicholas Locantore, Alvar Agusti, Ruth Tal-Singer
European Respiratory Journal Dec 2014, 44 (6) 1697-1700; DOI: 10.1183/09031936.00162414

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Eosinophilic inflammation in COPD: prevalence and clinical characteristics
Dave Singh, Umme Kolsum, Chris E. Brightling, Nicholas Locantore, Alvar Agusti, Ruth Tal-Singer
European Respiratory Journal Dec 2014, 44 (6) 1697-1700; DOI: 10.1183/09031936.00162414
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