- Blood eosinophil counts (BEC) are a promising biomarker for COPD1
- BEC may predict exacerbation risk and ICS responsiveness2,3
- BEC should be used in conjunction with other clinical assessments to individualise COPD treatment3
- GOLD suggest the use of blood eosinophil count thresholds to guide treatment decisions3
Can blood eosinophil counts be used as a COPD biomarker?
- Eosinophilic inflammation was present in 20-40% of stable COPD patients, with the amount of airway eosinophilia increasing during exacerbations 4
- Eosinophil derived granule proteins and proinflammatory mediators promote inflammation which has been associated with increased exacerbations 5
Can blood eosinophil counts predict COPD exacerbation risk?
- Patients with blood eosinophil counts of >340 cells/μL may have an increased risk of exacerbations, associated with a 1.76-fold increased risk of severe exacerbations.2
Can blood eosinophil counts predict ICS responsiveness?
Your patient’s blood eosinophil counts may help you identify if ICS is a suitable treatment for them.
- GOLD recommend using blood eosinophil counts as a biomarker in conjunction with clinical assessments when deciding whether to use ICS 3
- Blood eosinophil counts can help you to predict the likelihood of treatment benefit when using ICS 3
What do the guidelines say?
- Blood eosinophil count ≥300 cells/μL AND at least one exacerbation per year OR
- Blood eosinophil count ≥100 cells/μL AND ≥2 moderate exacerbations or at least one severe exacerbation leading to hospitalisation
- Blood eosinophil count ≥100 cells/μL in patients who develop further exacerbations on LAMA/LABA therapy
- Brusselle G, Pavord ID, Landis S, Pascoe S, Lettis S, Morjaria N, Barnes N, Hilton E. Blood eosinophil levels as a biomarker in COPD. Respir Med. 2018 May;138:21-31. doi: 10.1016/j.rmed.2018.03.016
- Vedel-Krogh S, Nielsen SF, Lange P, Vestbo J, Nordestgaard BG. Blood eosinophils and exacerbations in chronic obstructive pulmonary disease: The copenhagen general population study. Am J Respir Crit Care Med. 2016;193(9):965-974. doi:10.1164/rccm.201509-1869OC
- GOLD. Gold Initiative For The Diagnosis, Management, And Prevention of Chronic Obstructive Pulmonary Disease (2019 Report). 2019.
- Saha S, Brightling CE. Eosinophilic airway inflammation in COPD. Int J Chron Obstruct Pulmon Dis. 2006;1(1):39-47. doi:10.2147/copd.2006.1.1.39
- George L, Brightling CE. Eosinophilic airway inflammation: Role in asthma and chronic obstructive pulmonary disease. Ther Adv Chronic Dis. 2016;7(1):34-51. doi:10.1177/2040622315609251
- Yang IA, Clarke MS, Sim EH, Fong KM. Inhaled corticosteroids for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2012;(7):CD002991. doi:10.1002/14651858.cd002991.pub3
- NICE. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. 2018.