Relationship Between the Levels of Feno, Blood Eosinophils, and the Severity of Exacerbations in Patients With COPD: Results From COSYCONET
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Elsevier
Abstract
BACKGROUND: Exacerbation risk of patients with COPD is thought to be influenced by type 2
inflammation, with blood eosinophil counts and fractional concentration of exhaled nitric
oxide (FENO) as potential biomarkers.
RESEARCH QUESTION: Are there different associations of blood eosinophils and Feno with
exacerbation risk and severity in COPD, indicating a different role of local inflammation vs
systemic factors?
STUDY DESIGN AND METHODS: Data were taken from 3 visits (1.5 years apart) of the
longitudinal COPD and Systemic Consequences–Comorbidities Network (COSYCONET)
cohort, comprising a broad range of clinical and functional assessments. We determined the
relationships between eosinophil counts and FENO vs exacerbations, defined either via categorization
to Global Initiative for Chronic Obstructive Lung Disease group E ($ 2 moderate
or $ 1 severe), or as $ 1 severe exacerbation in the year before each visit. Analyses were
performed via generalized linear models.
RESULTS: The final data set included 384, 255, and 206 patients at visits 6, 7, and 8,
respectively. According to the multivariable analyses, exacerbation risk defined via Global
Initiative for Chronic Obstructive Lung Disease group E was associated with elevated values
($ 25 ppb) of FENO (P ¼ .003; OR, 1.90), but not eosinophil counts. In contrast, the risk for
severe exacerbations was linked to eosinophils, but not to FENO. This relationship was
expressed as either elevated risk with counts $ 100 and < 300 M/L (P ¼ .017; OR, 1.98) or as
reduced risk (P ¼ .046; OR, 0.57) < 100 M/L. The results were robust against the inclusion of
patients who actively smoke or with the comorbidity of asthma.
INTERPRETATION: Our observations suggest a differential role of type 2-related biomarkers
FENO and eosinophils for exacerbation risk and severity. FENO seemed superior regarding a
broad range of exacerbations predominantly involving local airway events, whereas systemic
eosinophils played a larger role in severe exacerbations. The findings also suggest that a low
eosinophil count might indicate a low risk of severe exacerbations, whereas highly elevated
counts did not play a statistical role.
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