%0 Journal Article %A Mona Bafadhel %A Susan McKenna %A Sarah Terry %A Vijay Mistry %A Mitesh Pancholi %A David Lomas %A Per Venge %A Mike Barer %A Seb Johnston %A Ian Pavord %A Chris Brightling %T A double-blind randomised control trial of peripheral blood eosinophils to direct prednisolone use in COPD exacerbations %D 2011 %J European Respiratory Journal %P 357 %V 38 %N Suppl 55 %X Introduction: COPD exacerbations and treatment responses are heterogeneous. Prednisolone therapy is associated with adverse events. Identifying steroid responsive subgroups maybe beneficialAims: To compare biomarker-directed prednisolone therapy to current standard treatment during COPD exacerbationsMethods: Patients with COPD exacerbations were randomised to receive standard therapy (ST) or a biomarker directed therapy (BT). BT patients were given prednisolone when the blood eosinophil count was >2% (biomarker positive) and placebo when ≤ 2% (biomarker negative) (see figure).Results: From 109 patients; 86 exacerbations were treated in the BT group and 80 in the ST group. Prednisolone prescription was reduced by 49% (95% CI 38 to 59, p<0.001) in the BT compared to ST group. There was no difference between groups in health status or FEV1 after 14 days treatment. Placebo administration did not result in excess treatment failure (hospitalisation or readmission) which occurred in 15% and 2% of biomarker negative patients in ST and BT groups (p=0.04). Improvements in health status after 14 days were greater in placebo treated patients compared to those in the ST group who were biomarker negative (mean change 1.01 vs. 0.56; mean difference 0.45; 95% CI 0.01 to 0.90; p=0.04)Conclusions: A phenotype-specific biomarker approach can safely and effectively be applied to prednisolone therapy during exacerbations. %U