Blood eosinophilia as predictor for patient outcomes in chronic obstructive pulmonary disease (COPD) exacerbations

INTRODUCTION: The eosinophilic phenotype of chronic obstructive pulmonary disease (COPD) has been demonstrated to respond better to corticosteroids and associated with better outcomes. This review aims to clarify the correlation of blood eosinophilia and outcomes patients with COPD exacerbations. METHODS: This is a review of cohorts and case-control studies that looked into eosinophilia and outcomes in exacerbations using the meta-analysis of observational studies in epidemiology (MOOSE) guidelines. The primary study outcome was length of hospitalization; other outcomes include readmission and mortality rate within one year, in-patient mortality, and need for mechanical ventilation. RESULTS: Six studies were included in the review. Patients with blood eosinophilia had significantly shorter hospital stay compared to non-eosinophilic patients (mean difference 0.68 days [95% CI 1.09,0.27]). Eosinophilic patients had significantly less frequent readmissions (OR 0.69 [95% CI 0.55,0.87]) but there was no statistically significant difference in the one-year mortality rate (OR 0.88 [95% CI 0.73, .06]). Analysis showed a trend toward lower in-patient mortality among eosinophilic patients (OR 0.53 [95% CI 0.27,1.05]). Furthermore, COPD patients with eosinophilia had significantly less need for mechanical ventilation during an exacerbation (OR 0.56 [95% CI 0.35,0.89]). CONCLUSION: COPD patients with blood eosinophilia had significantly shorter hospital stay, less frequent readmissions, and are less likely to require mechanical ventilation compared to the non-eosinophilic phenotype. 

Efficacy of tiotropium as add-on therapy for adults with uncontrolled asthma

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> The study aimed to evaluate efficacy of tiotropium as add-on therapy on top of standard regimens for uncontrolled asthma, specifically in terms of FEV1, morning and evening PEF, reduction in exacerbations, rescue medication use, and quality of life improvement.<br /><strong>METHODS:</strong> A search was done for eligible trials after which validity screen and data extraction was performed. Results were presented as mean differences, standard errors, and 95% confidence intervals, and graphically as forest plots. Estimates were pooled using the random effects model with I2 and Chi2 tests used to assess heterogeneity. Adverse events were reported as dichotomous variables.<br /><strong>RESULTS:</strong> Four studies were included totaling 1617 participants. The tiotropium group had statistically significant improvement in FEV1 (95% Cl, 0.14 [0.09, 0.19], p<0.00001), morning (95% Cl, 20.03 [11.71, 28.35], p<0.00001) with trend towards benefit in reduction of rescue medications (95% Cl, 0.12 [-0.17,0.4],p=0.42) and quality of life improvements (95% Cl, 0.1 [-0.05,0.25], p=0.20). Homogeneity (I2= 0%, Chi2= 0.47-3.22) was found across studies.<br /><strong>CONCLUSION:</strong> Tiotropium is associated with significant improvement in pulmonary function among patients with uncontrolled asthma, with possible benefit in reduction of rescue medications and quality of life improvement.</p>