Abstract
Background and objective The relationship between hospitalisation with an eosinophilic acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) and future relapses is unclear. We aimed to explore this association by following 152 patients for 12 months after hospital discharge or until their first moderate or severe flare-up.
Methods Patients hospitalised with AE-COPD were divided into eosinophilic and non-eosinophilic groups based on full blood count results on admission. All patients were treated with a course of systemic corticosteroid. The Cox proportional hazards model was used to study the association with the time to first re-exacerbation, a generalised linear regression model was applied to identify clinical variables related to the recurrence of relapses.
Results We did not find a difference in the time to the next moderate or severe exacerbation between the eosinophilic (≥2% of total leukocytes and/or ≥200 eosinophils·µL−1, N=51, median/interquartile range/: 21/10–36/weeks) and non-eosinophilic groups (N=101, 17/9–36/weeks, log-rank test: p=0.63). No association was found when other cut-off values (≥3% of total leukocytes and/or ≥300 eosinophils·µL−1) were used for the eosinophilic phenotype. However, the higher number of past severe exacerbations, a lower FEV1 at discharge and higher pack-years were related to shorter exacerbation-free time. According to a subgroup analysis (N=73), 48.1% of patients with initial eosinophilic exacerbations had non-eosinophilic relapses on re-admission.
Conclusions Our data do not support an increased risk of earlier recurring moderate or severe relapses in patients hospitalised with eosinophilic exacerbations of COPD. Eosinophilic severe exacerbations present a variable phenotype.
Footnotes
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Conflict of interest: Dr. Csoma has nothing to disclose.
Conflict of interest: Dr. Bikov has nothing to disclose.
Conflict of interest: Dr. Toth has nothing to disclose.
Conflict of interest: Prof. Losonczy has nothing to disclose.
Conflict of interest: V. Müller reports consultation fees from AstraZeneca, Chiesi, Berlin-Chemie/A. Menarini, Boehringer Ingelheim International GmbH, Teva Pharmaceutical Industries Ltd and GlaxoSmithKline plc, outside the submitted work.
Conflict of interest: Dr. Lazar has nothing to disclose.
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- Received July 31, 2020.
- Accepted November 23, 2020.
- Copyright ©ERS 2021
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