Division of Respiratory Diseases, Department of Internal Medicine, Atsugi City Hospital, 1-16-36 Mizuhiki, Atsugi-shi, Kanagawa, 243-8588, Japan.
Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Lung. 2020 Dec;198(6):925-931. doi: 10.1007/s00408-020-00397-4. Epub 2020 Oct 17.
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.
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.
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.
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.
慢性阻塞性肺疾病（COPD）通常包括中性粒细胞性气道炎症，在某些情况下还包括嗜酸性粒细胞炎症。吸入性皮质类固醇（ICS）可抑制气道嗜酸性粒细胞炎症，并减少急性加重（AE）。本研究通过血液嗜酸性粒细胞计数对 COPD 患者进行分类，探讨 ICS 与 AE 之间的关系。
回顾性分析 2014 年至 2017 年间的 244 例 COPD 患者，根据血液嗜酸性粒细胞计数（≥300/μL 和<300/μL）将患者分为两组。然后根据是否使用 ICS 将患者分为亚组。回顾性评估每组患者 AE 和 AE 合并肺炎的发生率及特征差异。
所有使用 ICS 的患者均使用 320μg 布地奈德，每日两次。在血液嗜酸性粒细胞计数≥300/μL 的患者中，使用 ICS 组的 AE 发生率明显低于未使用 ICS 组（P=0.023）。而在血液嗜酸性粒细胞计数<300/μL 的患者中，AE 发生率在两组间无显著差异。在血液嗜酸性粒细胞计数<300/μL 的患者中，使用 ICS 组的 AE 合并肺炎发生率较高（P=0.009）。而在血液嗜酸性粒细胞计数≥300/μL 的患者中，AE 合并肺炎发生率在两组间无显著差异。
ICS 可显著降低血液嗜酸性粒细胞计数≥300/μL 的 COPD 患者的 AE 发生率。同时，ICS 可显著增加血液嗜酸性粒细胞计数<300/μL 的患者的肺炎发生率。血液嗜酸性粒细胞计数可能是识别 ICS 在 COPD 中获益和风险的有用指标。
