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Benefits and Risks of Inhaled Corticosteroid Treatment in Patients with Chronic Obstructive Pulmonary Disease Classified by Blood Eosinophil Counts

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Abstract

Background

Chronic obstructive pulmonary disease (COPD) typically includes neutrophilic airway inflammation and eosinophilic inflammation in some cases. Inhaled corticosteroid (ICS) suppresses eosinophilic inflammation of the airway and reduces acute exacerbation (AE). The present study investigated the relationship between ICS and AE in patients with COPD classified by blood eosinophil counts.

Methods

Overall, 244 patients with COPD were retrospectively evaluated between 2014 and 2017 and classified into two groups based on blood eosinophil counts (≥ 300/μL and < 300/μL). These patients were then reclassified into subgroups of those with and without ICS. Differences in the characteristics and incidence of AE and pneumonia with AE in each subgroup were evaluated retrospectively.

Results

All patients with ICS used 320 μg budesonide twice daily. In the group with blood eosinophil counts ≥ 300/μL, patients with ICS had a significantly lower incidence of AE than those without ICS (P = 0.023). Meanwhile, no significant differences were observed in incidence of AE in the group with blood eosinophil counts < 300/μL. In the group with blood eosinophil counts < 300/μL, patients with ICS had a higher incidence of pneumonia with AE (P = 0.009). Conversely, no significant differences were observed in the group with blood eosinophil counts ≥ 300/μL.

Conclusions

ICS significantly reduced AE in COPD patients with blood eosinophil counts ≥ 300/μL. Meanwhile, ICS significantly increased pneumonia rate in patients with blood eosinophil count < 300/μL. Blood eosinophil count may be a useful indicator to identify the benefits and risks of ICS in COPD.

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Data Availability

All data used and generated in this study are available from the authors upon reasonable request.

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Authors and Affiliations

  1. Division of Respiratory Diseases, Department of Internal Medicine, Atsugi City Hospital, 1-16-36 Mizuhiki, Atsugi-shi, Kanagawa, 243-8588, Japan

    Zenya Saito, Masahiro Yoshida, Ayako Kojima, Kentaro Tamura & Tsukasa Hasegawa

  2. Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan

    Kazuyoshi Kuwano

Authors
  1. Zenya Saito
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  2. Masahiro Yoshida
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  3. Ayako Kojima
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  4. Kentaro Tamura
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  5. Tsukasa Hasegawa
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  6. Kazuyoshi Kuwano
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Contributions

ZS designed the study and drafted the manuscript. KK made substantial contributions to analysis and interpretation of data. MY, AK, KT, and TH contributed to data collection, analysis, and review of this manuscript. All authors read and approved the final manuscript. We are grateful to all the patients who participated in the current study.

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Correspondence to Zenya Saito.

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Saito, Z., Yoshida, M., Kojima, A. et al. Benefits and Risks of Inhaled Corticosteroid Treatment in Patients with Chronic Obstructive Pulmonary Disease Classified by Blood Eosinophil Counts. Lung 198, 925–931 (2020). https://doi.org/10.1007/s00408-020-00397-4

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  • DOI: https://doi.org/10.1007/s00408-020-00397-4

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