- Exacerbations are associated with a rapid lung function decline among patients with mild to moderate chronic obstructive pulmonary disease (COPD) with elevated blood eosinophil count (BEC; ≥350 cells/μL), not treated with inhaled corticosteroid (ICS).
- ICS use may mitigate lung function decline in these patients.
Why this matters
- Findings highlight the importance of recognising the need for ICS treatment to prevent rapid lung function loss related to exacerbations in COPD patients with high BECs in daily clinical practice.
- This prospective observational study included 25,560 patients with mild to moderate COPD (aged ≥35 years), with a history of tobacco smoking, and with at least 3 years of follow-up, using data from the UK Clinical Practice Research Datalink (CPRD) and Optimum Patient Care Research Database (OPCRD).
- Funding: AstraZeneca.
- Of 12,178 patients included, 8,981 (74%) received ICS.
- Overall, each exacerbation/year increase was associated with 5.8 mL/year (95% CI, 4.9-6.6) and 5.7 mL/year (95% CI, 3.6-7.7) faster forced expiratory volume 1 (FEV1) decline after initiation of ICS and non-ICS containing therapy, respectively.
- In patients with BEC ≥350 cells/μL not treated with ICS, a substantial excess FEV1 decline of 19.4 mL/year (95% CI, 12.0-26.7; P<.0001 was observed with every increase of one exacerbation per year.>
- This excess decline associated with increasing exacerbation rate was reduced by 15.1 mL/year (95% CI, 6.6-23.6) to 4.3 mL/year (95% CI, 1.9-6.7; P<.0001 in patients with bec cells treated ics.>
- Risk of bias.