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      Blood eosinophils: a biomarker of COPD exacerbation reduction with inhaled corticosteroids

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          Growing evidence suggests that blood eosinophil count is associated with patient responsiveness to inhaled corticosteroids (ICS). We performed post hoc predictive modeling on data from the FORWARD study and two replicate studies by Dransfield, to evaluate the relationships between baseline eosinophil count and the effect of ICS on exacerbations and lung function in patients with COPD.


          The studies assessed ICS/long-acting β 2 agonist (LABA) combinations vs LABA alone. Using data from each study, we modeled COPD exacerbation rates, predose FEV 1, and St George’s Respiratory Questionnaire score ([FORWARD only]) over a continuous range of eosinophils (0–1,000 eosinophils/µL in FORWARD, 0–993 eosinophils/µL in Dransfield).


          In all studies, ICS/LABA reduced exacerbations versus LABA alone across all eosinophil levels, with progressively greater reductions at increasing baseline blood eosinophil counts. In FORWARD, annual exacerbation rates ranged from 0.78 to 0.83 per year between 0 and 1,000 eosinophils/µL in the ICS/LABA arm, and from 0.81 to 1.54 per year in the LABA-only arm. In the Dransfield studies, exacerbation rates ranged from 0.54 to 1.02 per year in the ICS/LABA arm between 0 and 993 eosinophils/µL, and from 0.56 to 1.75 per year in the LABA-only arm. Change in FEV 1 was not associated with eosinophil count in ICS-treated patients in FORWARD, whereas an increased treatment benefit in terms of FEV 1 was observed at higher eosinophil levels in the Dransfield studies. ICS/LABA led to greater improvements in St George’s Respiratory Questionnaire total scores compared to LABA alone in patients in FORWARD with ≥67 eosinophils/µL.


          Higher blood eosinophil count in patients with COPD is associated with an increased beneficial effect from ICS in terms of exacerbation reduction. Further prospective data are required to assess the role of blood eosinophils as a biomarker for therapeutic recommendations.

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          Blood eosinophilia and the number of exacerbations in COPD patients [abstract]


            Author and article information

            Int J Chron Obstruct Pulmon Dis
            Int J Chron Obstruct Pulmon Dis
            International Journal of COPD
            International Journal of Chronic Obstructive Pulmonary Disease
            Dove Medical Press
            06 November 2018
            : 13
            : 3669-3676
            [1 ]University of Leicester, Leicester, UK, ss338@
            [2 ]National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK, ss338@
            [3 ]Respiratory Theme, National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK
            [4 ]Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
            [5 ]Glaxo Smith Kline, Brentford, London, UK
            [6 ]Barts and The London School of Medicine and Dentistry, London, UK
            [7 ]Chiesi Farmaceutici SpA, Parma, Italy
            [8 ]GSK, Uxbridge, London, UK
            [9 ]GSK, King of Prussia, PA, USA
            Author notes
            Correspondence: Salman H Siddiqui, National Institute for Health Research Leicester Biomedical Research Centre, Groby Road, Leicester LE3 9QP, UK, Tel +44 116 250 2873, Email ss338@
            © 2018 Siddiqui et al. This work is published and licensed by Dove Medical Press Limited

            The full terms of this license are available at and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

            Original Research

            Respiratory medicine

            ics, lung function, copd, fev1


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