P154 Blood eosinophil counts and escalation to high dose ICS, in COPD patients from a community service

Résumé fourni par la source

Higher blood eosinophil counts (BECs) in COPD are associated with an increased response to inhaled corticosteroid (ICS). Post-hoc analyses of randomised clinical trials of ICS-containing therapy have also shown that BEC reduction with ICS treatment occurs in some patients and is a biomarker of a positive treatment responses. In COPD patients with ongoing exacerbations plus high BEC while taking ICS, we investigated BEC change and clinical outcomes following an increase in ICS dose. BEC and exacerbation rates, were retrospectively analysed before and after an increase to high dose ICS, from patients under the care of a COPD community service (CCS), Manchester University NHS Foundation Trust. BEC were collected when patients reported a worsening of symptoms to the CCS. BEC are reported as median (BECmedian) or the highest (BEChighest) of any counts for each time-period; pre-ICS change (12-month period), and post-ICS change at 0–3 months (3m), 3–6 months (6m) and 6–12 months (12m). Results are reported as mean (SD) or median [range]. COPD patients (n=33) were 68.4 (9.7) years, 60.6% female with a CAT score of 23.3 (9.0), 30.3% were current smokers with a pack year history of 43.3 (20.2) and had an annual exacerbation rate of 3.2 (3.0). 57.6% of patients had a concomitant asthma diagnosis. BEC was collected on ≥1 occasion during follow-up for n=33 (249 individual counts); a median of 5.0 [3.0–25.0] counts were reported per patient. A reduction in BEC compared to baseline was observed at 12 months follow up for BEChighest(0.51 vs 0.30 x109/L, respectively, p<0.01, figure 1) and BECmedian(0.40 vs 0.28 x109/L, respectively, p=0.04). A numerical decrease in exacerbation rate was observed, however this was not statistically significant (3.0 vs 2.2, respectively, p=0.14). We provide evidence of a decrease in BEC following increase in ICS dose. Exacerbation rates were numerically (not statistically significantly) lower; these data support a larger study to further investigate higher ICS use in this COPD subgroup.

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