Shall We Focus on the Eosinophil to Guide Treatment with Systemic Corticosteroids during Acute Exacerbations of COPD?: PRO
In an era of precision medicine, it seems regressive that we do not use stratified approaches to direct treatment of oral corticosteroids during an exacerbation of chronic obstructive pulmonary disease (COPD). This is despite evidence suggesting that 40% of COPD patients have eosinophilic inflammati...
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doaj-dd6e13d62545438580a24d424cc554382020-11-25T01:05:28ZengMDPI AGMedical Sciences2076-32712018-09-01637410.3390/medsci6030074medsci6030074Shall We Focus on the Eosinophil to Guide Treatment with Systemic Corticosteroids during Acute Exacerbations of COPD?: PROJames Camp0Jennifer L. Cane1Mona Bafadhel2Respiratory Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX3 7FZ, UKRespiratory Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX3 7FZ, UKRespiratory Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX3 7FZ, UKIn an era of precision medicine, it seems regressive that we do not use stratified approaches to direct treatment of oral corticosteroids during an exacerbation of chronic obstructive pulmonary disease (COPD). This is despite evidence suggesting that 40% of COPD patients have eosinophilic inflammation and this is an indicator of corticosteroid response. Treatments with oral corticosteroids are not always effective and not without harm, with significant and increased risk of hyperglycemia, sepsis, and fractures. Eosinophils are innate immune cells with an incompletely understood role in the pathology of airway disease. They are detected at increased levels in some patients and can be measured using non-invasive methods during states of exacerbation and stable periods. Despite the eosinophil having an unknown mechanism in COPD, it has been shown to be a marker of length of stay in severe hospitalized exacerbations, a predictor of risk of future exacerbation and exacerbation type. Although limited, promising data has come from one prospective clinical trial investigating the eosinophil as a biomarker to direct systemic corticosteroid treatment. This identified that there were statistically significant and clinically worsened symptoms in patients with low eosinophil levels who were prescribed prednisolone, demonstrating the potential utility of the eosinophil. In an era of precision medicine our patients’ needs are best served by accurate diagnosis, correct identification of maximal treatment response and the abolition of harm. The peripheral blood eosinophil count could be used towards reaching these aims.http://www.mdpi.com/2076-3271/6/3/74COPDEosinophilsInflammation |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
James Camp Jennifer L. Cane Mona Bafadhel |
spellingShingle |
James Camp Jennifer L. Cane Mona Bafadhel Shall We Focus on the Eosinophil to Guide Treatment with Systemic Corticosteroids during Acute Exacerbations of COPD?: PRO Medical Sciences COPD Eosinophils Inflammation |
author_facet |
James Camp Jennifer L. Cane Mona Bafadhel |
author_sort |
James Camp |
title |
Shall We Focus on the Eosinophil to Guide Treatment with Systemic Corticosteroids during Acute Exacerbations of COPD?: PRO |
title_short |
Shall We Focus on the Eosinophil to Guide Treatment with Systemic Corticosteroids during Acute Exacerbations of COPD?: PRO |
title_full |
Shall We Focus on the Eosinophil to Guide Treatment with Systemic Corticosteroids during Acute Exacerbations of COPD?: PRO |
title_fullStr |
Shall We Focus on the Eosinophil to Guide Treatment with Systemic Corticosteroids during Acute Exacerbations of COPD?: PRO |
title_full_unstemmed |
Shall We Focus on the Eosinophil to Guide Treatment with Systemic Corticosteroids during Acute Exacerbations of COPD?: PRO |
title_sort |
shall we focus on the eosinophil to guide treatment with systemic corticosteroids during acute exacerbations of copd?: pro |
publisher |
MDPI AG |
series |
Medical Sciences |
issn |
2076-3271 |
publishDate |
2018-09-01 |
description |
In an era of precision medicine, it seems regressive that we do not use stratified approaches to direct treatment of oral corticosteroids during an exacerbation of chronic obstructive pulmonary disease (COPD). This is despite evidence suggesting that 40% of COPD patients have eosinophilic inflammation and this is an indicator of corticosteroid response. Treatments with oral corticosteroids are not always effective and not without harm, with significant and increased risk of hyperglycemia, sepsis, and fractures. Eosinophils are innate immune cells with an incompletely understood role in the pathology of airway disease. They are detected at increased levels in some patients and can be measured using non-invasive methods during states of exacerbation and stable periods. Despite the eosinophil having an unknown mechanism in COPD, it has been shown to be a marker of length of stay in severe hospitalized exacerbations, a predictor of risk of future exacerbation and exacerbation type. Although limited, promising data has come from one prospective clinical trial investigating the eosinophil as a biomarker to direct systemic corticosteroid treatment. This identified that there were statistically significant and clinically worsened symptoms in patients with low eosinophil levels who were prescribed prednisolone, demonstrating the potential utility of the eosinophil. In an era of precision medicine our patients’ needs are best served by accurate diagnosis, correct identification of maximal treatment response and the abolition of harm. The peripheral blood eosinophil count could be used towards reaching these aims. |
topic |
COPD Eosinophils Inflammation |
url |
http://www.mdpi.com/2076-3271/6/3/74 |
work_keys_str_mv |
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