Blood eosinophil counts, withdrawal of inhaled corticosteroids and risk of COPD exacerbations and mortality in the Clinical Practice Research Datalink (CPRD)

The aim of this study was to evaluate the risk of moderate and/or severe exacerbations and all-cause mortality in a large primary care population after withdrawal of ICS compared to continued users stratified by elevated blood eosinophil counts. We included subjects’ aged 40 or more who had a diagnosis of COPD. We excluded subjects with a history of asthma, pulmonary fibrosis, cardiac arrhythmia and bronchiectasis, COPD exacerbations or with a myocardial infarction. We evaluated the risk of COPD outcomes among subjects by various blood eosinophil thresholds that withdrew from ICS using Cox regression analysis adjusted for potential confounders. 48,157 subjects were diagnosed with COPD between 1st January 2005 to 31st January 2014. Withdrawal of ICS was not associated with an increased risk of moderate-to-severe exacerbations among subjects with absolute blood eosinophil counts ≥0.34 x 109 cells/L (adjusted hazard ratio [adj. HR] 0.72; 95% confidence interval [CI] 0.63-0.81) or relative counts ≥ 4.0% (adj.HR 0.72; 95% CI: 0.66-0.78). Withdrawal of ICS was not associated with increased risk of severe exacerbations among subjects with absolute blood eosinophil ≥ 0.34 x 109 cells/L (adj.HR 0.82; 95% CI: 0.61-1.10) or relative blood eosinophil counts ≥ 4.0%(adj.HR 0.80; 95% CI: 0.61-1.04). No increased risk of all-cause mortality among subjects who withdrew from ICS by elevated absolute or relative blood eosinophil counts. In a real-world primary care population,...

Source: European Respiratory Journal - November 20, 2019 Category: Respiratory Medicine Authors: Oshagbemi, O., Franssen, F., Wouters, E., Maitland-Van Der Zee, A.-H., Driessen, J., De Boer, A., Devries, F., Braeken, D. Tags: Airway pharmacology and treatment Source Type: research