The Absolute Eosinophil Count : A potential Biomarker of Response to inhaled Corticosteroids in respiratory Patients

Dijk, A.E.M. van (2017) The Absolute Eosinophil Count : A potential Biomarker of Response to inhaled Corticosteroids in respiratory Patients. thesis, Medicine.

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Abstract

Introduction: The burden of asthma and chronic obstructive pulmonary disease (COPD) on society is high and therefore research about optimal treatment in these patient groups has become a wide field of interest. Inhaled corticosteroids (ICS) are used in both asthma and COPD patients. The peripheral blood eosinophil count (EO-count) has been suggested to be a promising biomarker for the effectiveness of ICS. However, little is known about the predicting role of the EO-count in a combined approach of patients with asthma, COPD and asthma-COPD overlap (ACO) in primary care. Aim: This study aims to investigate the ICS treatment response in relation to different EO-counts in real life primary care respiratory patients data. Methods: This retrospective observational study used anonymized medical data from 2007 till 2016, derived from the Asthma/COPD(AC)-service. Absolute EO-counts were categorized as follows: ≤150 cells/μL, 151-300 cells/μL, 301-400 cells/μL and > 400 cells/μL. The primary outcome was the ICS treatment response in terms of improved disease control, measured by the Asthma Control Questionnaire(ACQ) and Clinical COPD Questionnaire(CCQ), for the four categories of EO-counts. As secondary outcome, ICS treatment response in terms of lung function improvement and exacerbation rate was analyzed. Analyses were performed for all three diseases combined, as well as all three separately. Results: 215 asthma patients, 74 COPD patients and 48 ACO patients met study eligibility criteria. Analyses of the entire study population showed that, after ICS treatment, patients with an EO-count > 400 cells/μL at baseline were more likely to improve their disease control compared to patients with an EO-count between 151-300 cells/μL (p=0.005). When performing specific analyses into patients classified by their diagnosis, similar results were solely observed in COPD patients. Furthermore, no significant differences in terms of lung function improvement and exacerbation rate were identified related to the EO-count. Conclusion: In patients with a high EO-count at baseline, ICS treatment is associated with larger improvements of disease control compared to patients with a low EO-count. The absolute EO-count is potentially an important biomarker that could contribute to treatment decision making in primary care respiratory patients. These results suggest the need for prospective randomized control trials on larger sample sizes. Key words: Primary care, Blood eosinophil count, Inhaled corticosteroids, Disease Control

Item Type:	Thesis (Thesis)
Supervisor name:	Supervisor: and Kocks, dr. J.W.H. and Flokstra-de Blok, dr. B.M.J. and Daily supervisor: and Baretta, drs. H.J. and Department of General Practice University Medical Center Gro
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:06
Last Modified:	25 Jun 2020 11:06
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2589

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