| Summary: | In COPD, clinically relevant exacerbation phenotypes, such as “eosinophilic” and “bacterial”, can be identified with simple biomarkers. Studies are needed to validate the use of these biomarkers to direct therapy for acute exacerbation (AECOPD).
Setting: Chest Department, Assiut University Hospital.
Objective: To evaluate the use of blood eosinophilia in directing steroids therapy in AECOPD.
Design: This study included 71 COPD patients with 106 exacerbations. The bacterial exacerbation phenotype received antibiotic based therapy for 7 days and eosinophilic exacerbation phenotype received antibiotic + oral prednisolone. Responses were recorded on days 7–14.
Results: There was significant improvement in pulmonary function, arterial blood gases in both groups in day 7, 14 compared to admission. The improvement of FEV1, eosinophilic percentage and count, C-reactive protein, Cor-Pulmonale and PaO2 was more significant in eosinophilic phenotype. There was no difference in parameters of treatment failure and patient’s outcome between bacterial exacerbations who did not receive prednisolone compared to eosinophilic group.
Conclusion: In AECOPD, it would be valuable to suggest that blood eosinophilia (>2%) is a simple accessible routine biomarker to identify phenotypes that actually need to add oral steroid to their management, and those for which there is a greater risk of harm.
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