Blood eosinophil-guided therapy for COPD exacerbations

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, and acute exacerbations are the primary cause of health-care utilisation in COPD. 1 Chen S Kuhn M Prettner K et al. The global economic burden of chronic obstructive pulmonary disease for 204 countries and territories in 2020–50: a health-augmented macroeconomic modelling study. Lancet Glob Health. 2023; 11: 1183-1193 Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar These exacerbations are associated with a decline in lung function, reduced quality of life, and increased mortality. 2 Agusti A Celli BR Criner GJ et al. Global Initiative for Chronic Obstructive Lung Disease 2023 report: GOLD executive summary. Am J Respir Crit Care Med. 2023; 207: 819-837 Crossref PubMed Scopus (21) Google Scholar Interventions to prevent exacerbations include standard inhaler therapy: inhaled glucocorticoids, long-acting muscarinic antagonists, and long acting β2-agonists. 2 Agusti A Celli BR Criner GJ et al. Global Initiative for Chronic Obstructive Lung Disease 2023 report: GOLD executive summary. Am J Respir Crit Care Med. 2023; 207: 819-837 Crossref PubMed Scopus (21) Google Scholar Once hospitalised, it is advised that patients be treated with systemic glucocorticoids per Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, with the understanding that prolonged corticosteroid courses can increase the risk of pneumonia and mortality. 2 Agusti A Celli BR Criner GJ et al. Global Initiative for Chronic Obstructive Lung Disease 2023 report: GOLD executive summary. Am J Respir Crit Care Med. 2023; 207: 819-837 Crossref PubMed Scopus (21) Google Scholar , 3 Sivapalan P Ingebrigtsen TS Rasmussen DB et al. COPD exacerbations: the impact of long versus short courses of oral corticosteroids on mortality and pneumonia: nationwide data on 67 000 patients with COPD followed for 12 months. BMJ Open Respir Res. 2019; 6: e000407 PubMed Google Scholar Blood eosinophil-guided oral prednisolone for COPD exacerbations in primary care in the UK (STARR2): a non-inferiority, multicentre, double-blind, placebo-controlled, randomised controlled trialBlood eosinophil-directed prednisolone therapy at the time of an acute exacerbation of COPD is non-inferior to standard care and can be used to safely reduce systemic glucocorticoid use in clinical practice. Full-Text PDF Open Access