Predictive Value Of Peripheral Blood Eosinophil Count In Response To Inhaled Glucocorticoid Therapy In Patients With COPD

Objective:Peripheral blood eosinophil counts are currently an important biomarker for evaluating whether patients with COPD are treated with inhaled glucocorticoids.The purpose of this study was to investigate the predictive value of peripheral blood eosinophil count in the response to ICS treatment in patients with COPD during acute exacerbation and stable phase.Methods:A total of 82 AECOPD patients who were first admitted to the Department of Respiratory Medicine of the Second People’s Hospital of Wuhu City from September 2018 to December 2019 and required hospitalization were selected,according to the absolute counts of peripheral blood eosinophils at admission,the patients were divided from low to high into three groups:0～99/uL(low group),100～299/uL(middle group),and 300/uL and above(high group).During the acute exacerbation of hospitalization,inhaled budesonide(Linshu)2mg was given 3 times a day in addition to routine treatment,and the difference of CAT score and MMRC score before and after treatment was evaluated in each group during hospitalization.In the stable phase,all patients were treated with budesonide formoterol inhaler(Sybicol)320/9.0ug once a inhale,twice a day,the difference of the changes of lung function FEV1(Forced Expiratory Volume In One Second),readmission/hospitalization times of acute exacerbation and mortality of three groups during stable period were observed.At 3,6,9 and 12 months after discharge,the changes of eosinophil counts in peripheral blood of each group were observed,and the correlation between its fluctuation and the efficacy of ICS was discussed.Data statistics were analyzed by SPSS19.0 software.One-way analysis of variance was used when the measurement data of multiple groups were matched with normal distribution variance,multiple comparisons using LSD test(Fisher S Least Significant Difference),If One-way ANOVA condition is not satisfied,One-way ANOVA is still used under the condition that the normality is not satisfied,and Welch’s ANOVA is used when the homogeneity of variance is not satisfied.The enumeration data were compared with χ2 test,and the test level was P values were less than 0.05 is statistically significant.Results:A total of 82 patients were enrolled,including 27 in the low group,26 in the middle group,and 29 in the high group,baseline characteristics(age,sex,complicated-smoking history,CAT score and MMRC grade at admission,FEV1)among the three groups have no statistical differences.During hospitalization,there was a statistical difference in the change of CAT(Δ CAT)between the three groups before and after treatment at discharge,pairwise comparison showed that there was a statistical difference between the high group and the low group,and between the middle group and the low group;The difference of the change of MMRC(ΔMMRC)before and after treatment was statistically significant between the three groups at discharge,which was mainly reflected between the high group and the low group.During the 1-year follow-up period,there was a statistical difference in the absolute value of FEV1 change(ΔFEV1)among the three groups.Pairwise comparison among the three groups:there was a statistical difference between the high group and the middle group,the high group and the low group,the middle group and the low group.There was a statistical difference in the number of re-visits/readmissions because of acute exacerbations in the three groups during the 1-year follow-up.Pairwise comparison among the three groups:there was a statistical difference between the high group and the middle group,the high group and the low group,the middle group and the low group.Blood eosinophil counts in the three groups fluctuated during the 1-year follow-up.Pairwise comparison among the three groups showed that the change range of the high group was greater than that of the middle group and the low group,and the change range of the middle group was greater than that of the low group,the difference was statistically significant(all P values were less than 0.05).Conclusion:The peripheral blood eosinophil counts of patients with COPD,whether in acute exacerbation or stable phase,may be a useful biomarker to guide the use of ICS.The higher the peripheral blood eosinophil counts in patients with acute exacerbation,the greater the improvement in CAT and MMRC scores.During the stable period,patients with eosinophil counts were able to benefit from decreased FEV1 and acute exacerbation re-visits/readmission rates in the high-eosinophil group at the time of enrolment,although eosinophil counts were fluctuated during the continuous use of ICS.