Benefits and Risks of Inhaled Corticosteroid Treatment in Patients with Chronic Obstructive Pulmonary Disease Classified
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COPD
Benefits and Risks of Inhaled Corticosteroid Treatment in Patients with Chronic Obstructive Pulmonary Disease Classified by Blood Eosinophil Counts Zenya Saito1 · Masahiro Yoshida1 · Ayako Kojima1 · Kentaro Tamura1 · Tsukasa Hasegawa1 · Kazuyoshi Kuwano2 Received: 23 May 2020 / Accepted: 7 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords Chronic obstructive pulmonary disease · Eosinophils · Inhaled corticosteroids * Zenya Saito [email protected] Masahiro Yoshida [email protected] Ayako Kojima [email protected] Kentaro Tamura [email protected] Tsukasa Hasegawa [email protected] Kazuyoshi Kuwano [email protected] 1
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
2
Introduction Chronic obstructive pulmonary disease (COPD) is a com‑ mon, chronic disease characterized by persistent respira‑ tory symptoms and airflow limitations owing to airway or alveolar abnormalities usually resulting from substantial exposure to noxious particles or gases [1]. Tobacco smoke is considered a major cause of this disease. Toxic compo‑ nents of tobacco smoke produce inflammation in the res‑ pi
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