Eosinophils in COPD&nbsp;
In patients with COPD, raised eosinophil levels in the blood are associated with higher eosinophil levels in the lungs, which is a biomarker of type 2 inflammatory activity in the airway.1-4&nbsp;It has been found that up to 37% of COPD patients show indication of type 2 inflammation.5&nbsp;
<ul>
 <li><a href="https://pro.campus.sanofi/copd/articles/role-of-type-2-inflammation">Link to Role of Type 2 Inflammation in COPD</a>&nbsp;</li>
</ul>
Raised blood eosinophil levels are detectable by ordering a complete blood count with differential. A large population-based study (N=39,824) evaluated the stability of blood eosinophilia over time. The stability of the blood eosinophil count was observed to be higher in patients with COPD with baseline counts &lt;340 cells/µL vs ≥340 cells/µL. The findings from this study extend the understanding of blood eosinophil as a potential biomarker.5 &nbsp;
Raised blood eosinophil count in COPD is associated with poor clinical outcomes and increased healthcare cost&nbsp;
Raised blood eosinophil count in COPD increased the risk of exacerbation,6 1-year COPD-related readmission,7 and severe exacerbations8 as shown in the illustration below:&nbsp;

COPD exacerbation risk increases with higher eosinophil counts. In the COPDGene study, COPD patients with blood eosinophil count ≥300 cells/μL demonstrated an increased risk of exacerbations. This was prospectively validated in the ECLIPSE study.6
&nbsp;
Type 2 inflammation in COPD (Eosinophilic COPD) and its risks&nbsp;
Raised blood eosinophils are associated with higher emergency department visits, outpatient visits, numbers of prescriptions* and increased rate of lung function decline.9,10 Raised eosinophils in COPD may also lead to increased risk of 1-year COPD-related readmission, decreased time to first COPD-related readmission and increased number of 1-year COPD-related Emergency Department (ED) visits7 as shown in the illustration and table below: &nbsp;
Risks associated with raised blood eosinophil levels&nbsp;

To learn more about the impact of raised eosinophiles in COPD read this article&nbsp;
An Overview of the impact of Type 2 Inflammation in COPD: Insights from Dr. Surya Bhatt&nbsp;
&nbsp;
<h2>Impact of blood eosinophil count in COPD on management decisions&nbsp;</h2>

Initial pharmacological management (Group E†)1:&nbsp;
GOLD references suggest that ICS should be added to long-acting bronchodilators therapy in patients with high blood eosinophils counts (≥300 cells/µL). Consider triple therapy (LABA+LAMA+ICS) if eosinophil count is ≥300 cells/μL and this is based on the effect of ICS on exacerbation prevention correlated to blood eosinophil count. There is no direct data on initiation with triple therapy in newly diagnosed patients. However, available studies in treated patients provide a rationale to initiate treatment with triple therapy in patients with high eosinophils counts (≥300 cells/µL).1&nbsp;
&nbsp;
Blood eosinophil count impact on initial management decisions, according to GOLD references1&nbsp;

Follow-up pharmacological management:&nbsp;
Exacerbations:1 &nbsp;
GOLD references recommend escalation to LABA + LAMA for patients with persistent exacerbations on bronchodilator therapy.&nbsp;
ICS is suggested to be added to LABA + LAMA in patients who develop further exacerbations. Beneficial response of ICS may be observed at blood eosinophil counts of ≥100 cells/μL.&nbsp;
For patients treated with LABA + LAMA + ICS or those with eosinophil counts of &lt;100 cells/μL who still have exacerbations — <a href="https://goldcopd.org/2025-gold-report/">Please refer to GOLD guidelines for more information</a>&nbsp;
&nbsp;
Blood eosinophil count impact on follow-up pharmalogical management decisions, according to GOLD1&nbsp;

*Regardless of inhaled therapy&nbsp;
†Group “E” are patients with frequent exacerbations (defined as ≥2 in the past 12 months or 1 exacerbation requiring hospitalization).&nbsp;
&nbsp;
COPD, chronic obstructive pulmonary disease; ED, emergency department; FEV1, forced expiratory volume in first second; GOLD, Global Initiative for Chronic Obstructive Lung Disease; HR, hazard ratio; ICS, inhaled corticosteroid; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; OR, odds ratio; IRR, incidence rate ratio; ULN, upper limit of normal.&nbsp;

This article discusses the role of blood eosinophils as a biomarker in patients with Chronic Obstructive Pulmonary Disease (COPD). It highlights that measuring blood eosinophil levels can help predict exacerbations, guide corticosteroid therapy, and tailor treatment strategies for COPD patients. The article emphasizes the importance of personalized treatment approaches based on eosinophil counts to improve patient outcomes and manage COPD more effectively.

Blood Eosinophils as a Biomarker in Patients with COPD

CHRONIC-OBSTRUCTIVE-PULMONARY-DISEASE-(COPD)

COPD exacerbation is an event characterized by increased dyspnea and/or cough and sputum that worsens in less than 14 days and may be accompanied with tachypnea and/or tachycardia.2&nbsp;
COPD exacerbations are often associated with increased local and systemic inflammation caused by airway infection, air pollutants, or other airway insults.2 Type 2 inflammation, characterized by raised eosinophil count, is associated with increased risk of COPD exacerbations.3 &nbsp;
Click <a href="https://pro.campus.sanofi/copd/articles/an-overview-of-the-impact-of-type-2-inflammation-in-copd-insights-from-dr-surya-bhatt">here</a> to understand how type 2 inflammation is linked to the risk of COPD exacerbations.
The treatment goals of COPD exacerbations are to minimize the negative impact of the current exacerbation and to prevent occurrence of subsequent events.2 The risk of subsequent events has been shown to increase with each exacerbation.1&nbsp;Furthermore, frequent COPD exacerbations lead to accelerated lung function decline4 and worsening of symptoms.2
To know more, listen to the <a href="https://www.emjreviews.com/respiratory/podcasts/the-negative-impact-of-chronic-inflammation-on-quality-of-life-in-patients-with-copd/">podcast</a> on COPD exacerbations and their impact on patients’ quality of life by Prof. Nicola Hanania, Professor of Medicine, Section Chief of Pulmonary Critical Care and Sleep Medicine at the Ben Taub Hospital in Houston, Texas, and Director of the Airways Clinical Research Center, ACRC at the Bear College of Medicine.
&nbsp;
<h2>Pathophysiology of acute COPD exacerbation&nbsp;</h2>
COPD exacerbations are often associated with increased local and systemic inflammation.2 Air pollutants, such as particulate matter, sulfur dioxide, and cigarette smoke can increase exacerbations. 5,6 &nbsp;
In stable COPD, there is an increase in the release of inflammatory cells such as T- lymphocytes and macrophages in the bronchial mucosa.6 In patients with stable, but more severe COPD, there is an increase in airway neutrophils, which further elevate during exacerbations.6&nbsp;
A substantial percentage of patients with COPD show raised eosinophils in the airways, lungs, and blood;2 however, significant variations in blood eosinophil levels are observed during both stable COPD and acute exacerbations.7 Eosinophilic inflammation has been attributed as a cause for exacerbations. Patients with raised eosinophils during stable disease experience frequent and severe exacerbations.7 Patients with mild COPD and exacerbations have also demonstrated an increased number of eosinophils in their airways on bronchial biopsy.6&nbsp;
To know more, please read the article <a href="https://pro.campus.sanofi/copd/articles/blood-eosinophils-as-a-biomarker-in-patients-with-copd">Blood Eosinophils as a Biomarker in Patients with COPD</a>.
According to Dr Surya Bhatt, a distinguished professor of medicine at the University of Alabama at Birmingham and a COPD researcher, the burden and risk of exacerbations in COPD is profound and "there's plenty of data to suggest that these exacerbations are associated with lung function decline."
Click <a href="https://pro.campus.sanofi/copd/articles/the-burden-and-risk-of-exacerbations-in-copd-according-to-dr-surya-bhatt">here</a> to watch the full video by Dr Surya Bhatt.

<h2>Etiology of acute COPD exacerbation</h2>
COPD exacerbations are triggered by a variety of factors including airway infection, air pollution or other airway insults, with viral infections being a key trigger.2&nbsp;
Viral infections result in more severe exacerbations that are associated with longer recovery times, compared with those triggered by other factors.2 Such exacerbations also have a greater likelihood of hospital admission. Human rhinovirus, influenza and parainfluenza and metapneumovirus are the most common viruses implicated in airway infections causing exacerbations and can be isolated within a week of onset of exacerbation.2&nbsp;
The exact role of bacteria as a causative agent in COPD exacerbations remains uncertain as the same bacteria were identified in both stable disease and during exacerbations.6 Short-term exposure to environmental pollutants, such as particulate matter and nitrous oxide, has been linked to increased exacerbations, hospital admissions, emergency room, and outpatient visits and increased mortality.2&nbsp;
Read more about the impact of exacerbations in COPD <a href="https://pro.campus.sanofi/copd/articles/the-impact-of-exacerbations-in-copd">here</a>.

Dr. Surya Bhatt <a href="https://pro.campus.sanofi/copd/articles/the-burden-and-risk-of-exacerbations-in-copd-according-to-dr-surya-bhatt">highlights</a>, "The hazard of mortality is about twice if you get two severe exacerbations as opposed to one severe exacerbation. And the hazard of mortality is fivefold if you get ten exacerbations as opposed to one severe exacerbation."
Click <a href="https://pro.campus.sanofi/copd/articles/the-burden-and-risk-of-exacerbations-in-copd-according-to-dr-surya-bhatt">here</a> to watch Dr. Surya Bhatt’s video where he talks about the burden and risk of exacerbations in COPD.&nbsp;
&nbsp;
<h2>Symptoms of acute COPD exacerbation</h2>
COPD exacerbations may be associated with a wide range of clinical signs and symptoms.5 The signs and symptoms during exacerbation are similar to what the patients usually experience; however, their severity is increased. COPD exacerbations are associated with deterioration in airflow limitation and dynamic hyperinflation, occurring as a result of bronchospasm, airway edema and excessive sputum production due to airway inflammatory responses.6 These changes primarily contribute to increased dyspnea, the most common symptom experienced during exacerbations.6
The other symptoms of COPD exacerbation include severe and strenuous cough, increased sputum volume, change in sputum color from whitish to yellow/green, and hemoptysis.5 On physical examination, increase in expiratory wheezing and rhonchi may be evident along with warning signs of impending respiratory failure, such as paradoxical breathing and respiratory alternans due to muscle fatigue.5
&nbsp;
<h2>COPD exacerbation criteria and diagnosis&nbsp;</h2>
Several staging systems for classification of the severity of COPD exacerbations without respiratory failure were used previously; however, none were prospectively validated.5 The 2025 GOLD report proposed a classification system for exacerbation severity, using the Delphi approach after an exhaustive literature review.2&nbsp;
Exacerbations can be classified as mild, moderate, and severe after their onset.2 Classification of COPD exacerbation severity should be followed up with identification of cause by viral testing, sputum culture or other investigations.&nbsp;
&nbsp;
Classification of COPD exacerbation severity2,8

Click <a href="https://goldcopd.org/2025-gold-report/">here</a> for the 2025 GOLD report to learn more about COPD exacerbation diagnosis and severity.
&nbsp;
<h3>Differentiating asthma and COPD exacerbations9&nbsp;</h3>
Both asthma and COPD are obstructive lung disorders characterized by reduced pulmonary airflow due to increased inflammation and may present with acute exacerbations. Although the two conditions show some overlap in clinical features, the guideline-recommended management strategies and goals are different for both. Thus, it is important to distinguish between them for accurate diagnosis.&nbsp;
&nbsp;
COPD and Asthma: Distinguishing features9

<h2>Treatment for acute COPD exacerbation</h2>
Minimizing the negative impact of ongoing COPD exacerbations and reducing the number and COPD exacerbation severity is critical to COPD management.10&nbsp;

Approximately four in five exacerbations are managed in outpatient setting using bronchodilators, corticosteroids and antibiotics.2 On arrival in emergency department, it should be assessed if the episode is life threatening and/or requires noninvasive ventilation.2&nbsp;
A life-threatening episode presents with signs of acute respiratory failure (respiratory rate, &gt;24 breaths/minute; use of accessory respiratory muscles; acute changes in mental status; hypoxemia not improving with supplemental oxygen and requirement of FiO2 &gt;40%; hypercarbia).2 Such patients should be admitted in a setting where they can be properly monitored and managed.2
&nbsp;
Management of severe, but not life-threatening exacerbations2

Learn more about the <a href="https://goldcopd.org/2024-gold-report/">GOLD recommendations for treatment and management of COPD</a>.
&nbsp;
<h4>COPD exacerbation guidelines for treatment</h4>
Please find below key recommendations by the European Respiratory Society (ERS) and American Thoracic Society (ATS) for the management of COPD exacerbations.&nbsp;
&nbsp;
<h3>Key ERS/ATS recommendations for COPD exacerbation12</h3>

The GOLD 2025 report presents few key points for management of all COPD exacerbations.2
&nbsp;
Key points for management of all COPD exacerbations2

Acute COPD exacerbations are linked to significant disease progression. Uncover criteria, symptoms, and treatment guidance to manage them in your patients.

Understanding and Managing COPD Exacerbations

Symptoms to be considered for diagnosis of COPD 
One of the most characteristic symptoms of Chronic Obstructive Pulmonary Disease (COPD) is dyspnea or shortness of breath. Dyspnea is often the first noticeable symptom and tends to progressively worsen, particularly with physical activity. Cough is another symptom of COPD and is typically a chronic, productive cough. It is often described as an ongoing cough that produces a significant amount of mucus (sputum or phlegm). These symptoms can fluctuate day to day and may manifest years before airflow obstruction develops.1 
It is crucial to evaluate individuals, especially those with COPD risk factors, who present with these symptoms to identify potential underlying causes. Additionally, airflow obstruction can exist without chronic dyspnea, cough, or sputum production, and conversely, these symptoms may occur without airflow obstruction.1
Dyspnea
Shortness of breath, also known as dyspnea, is a primary indication of COPD and significantly contributes to the disease's associated disability and anxiety. Dyspnea is common at all stages of airflow obstruction, especially during exertion or physical activity. This symptom includes both a sensory experience and an effective response. Patients with COPD often characterize their dyspnea as feeling like they are exerting more effort to breathe, experiencing chest tightness, a need for air, or a sensation of suffocating. Nonetheless, the terms used to describe dyspnea can differ from one person to another and across cultures.1
Dyspnea is commonly encountered at all levels of impaired airflow and is especially noticeable during physical exertion or activity. In primary care settings, more than 40% of individuals with a COPD diagnosis report experiencing moderate to severe dyspnea.1 
Dyspnea arises from multiple neurophysiological processes that disrupt or alter normal respiration. In COPD, decreased airflow and gas exchange, air trapping, and hyperinflation of the lungs lead to multiple sources of neural input that reach the somatosensory cortex and contribute to dyspnea. These inputs include afferent sensory input from respiratory muscles, feedback from chemoreceptors and irritant receptors in the lungs and airways, and increased corollary neural input from the brainstem and cortical motor centers.2
In the GOLD clinical classification system, dyspnea is assessed using the 5-level modified Medical Research Council (mMRC) scale which is the first questionnaire developed to measure breathlessness. Of note, mMRC score has a strong correlation with other comprehensive health status indicators and can forecast the risk of mortality in the future.1

Chronic cough
Chronic cough is a persistent cough that lasts 8 weeks or more in adults.3 Chronic cough is often the first symptom of COPD and may be productive (with mucus) or unproductive (dry). Patients often dismiss it as a typical result of smoking and/or exposure to environmental factors. In some cases, significant airflow obstruction may develop even without cough. In patients with severe COPD, syncope during coughing can happen due to rapid increases in intrathoracic pressure during extended coughing episodes.1 
Sputum (mucus) production
Patients with COPD commonly raise small quantities of tenacious sputum with coughing. Patients who produce large volumes of sputum may have underlying bronchiectasis.1 
As per GOLD report, the follow-up checklist includes changes in sputum volume and color (from least to most purulent: mucus; mucopurulent; purulent). Modulating antibiotic therapy based on the observed sputum color can be done safely without adverse effects when the sputum is white or clear. The appearance of purulent sputum indicates a rise in inflammatory mediators and can potentially signal the beginning of a bacterial exacerbation, although this correlation is relatively weak.1
Evaluating sputum production can be challenging, as patients may swallow it rather than expectorate, a behavior influenced by cultural and gender differences. Additionally, sputum production can be intermittent, with periods of flare-ups alternating with remissions.1 
Wheezing and chest tightness
Inspiratory and/or expiratory wheezes, along with chest tightness, can vary in intensity both between days and within the same day. Alternatively, auscultation may reveal widespread inspiratory or expiratory wheezes.1
Chest tightness typically follows physical exertion, is often difficult to pinpoint, and is muscular in nature, potentially resulting from isometric contraction of the intercostal muscles. The absence of wheezing or chest tightness does not rule out a diagnosis of COPD, nor does the presence of these symptoms definitively indicate asthma.1
It is different from whooping cough (also known as pertussis) which is caused due to a highly contagious bacteria Bordetella pertussis. It primarily affects the respiratory system, leading to severe coughing fits that may end with a "whooping" sound when the person breathes in.4 
Fatigue
Fatigue is among the most common and distressing symptoms experienced by individuals with COPD. Fatigue impacts a patient’s ability to perform daily activities and their quality of life.1
Additional symptoms
Additional clinical features such as weight loss, muscle mass loss, and anorexia are common problems in patients with severe and very severe COPD.1
<ul>
 <li style="list-style-type: none;">To learn more about the symptoms, read this article <a href="https://goldcopd.org/2025-gold-report/" style="color:#0563c1; text-decoration:underline">Global Initiative for Chronic Obstructive Lung Disease</a></li>
</ul>

Chronic Obstructive Pulmonary Disease (COPD), as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), is a heterogeneous lung condition characterized by chronic respiratory symptoms like dyspnea, cough, sputum, and exacerbations.1

Comprehensive Guide to COPD Symptoms: Dyspnea, Chronic Cough, and More

RESPIRATORY

Understanding type 2 inflammation may help shed light on why some patients continue to exacerbate. Watch this video to learn how.

One minute to ignite new thinking in COPD

To read the full content, activate your Sanofi Campus account. Please confirm your email address in the email you received.

If you didn't receive our first email at {email} to confirm your account you can request a new one below. If you don't see it, you may need to check your spam folder.

This information will only be used to validate your account and will not be distributed.

title

Before starting exploring, we can suggest you specific and relevant content

Title

This website is for healthcare professionals only.

Welcome to BP Sanofi Campus

Create new password

To offer you a personalised experience, you must

Your profile is incomplete

The ADCT gives a measure of how controlled the eczema is. Answer these 6 simple questions with your patient to find the ADCT score. It will indicate proper course of action.

Atopic dermatitis, a type of eczema, may be affecting your Patient's life in more ways than you know.

Take the Atopic Dermatitis Control Test (ADCT)

Enjoy more exclusive content{newline}by <a>registering today</a>

Already have an account? <a>Sign in here</a>

Best practices on optimising patient care

Get a customised view of the topics that you're interested in, along with the ability to save content to watch or read at a later date.

Unlimited access to premier content, white papers, case studies, research papers, webinars, training, and up-to-date scientific medical resources.

Personalised content based on your areas of interest

Connect and stay up-to-date with peers in your area of speciality and topics of interest through free events and leadership forums.

Please sign in to continue and read the full article

Please sign up to continue reading the full article.

We respect your privacy and will not share your information with any 3rd parties.

Topical guides written specifically for patients

Unlimited access to the latest patient guide guides and resources. Share content with your patients with easy-to-use online tools.

Please complete your profile to read the content.

Your profile is not validated yet. Please verify your inbox.

Restricted Access

We can't find the page you're looking for

You are going to a website that is not operated by Sanofi. Sanofi has no control over the content or availability of linked sites or resources, and accepts no liability or responsibility for them or for any loss or damage that may arise from your use of them. Please ensure that you read the legal and privacy policy sections of any third-party site to which you link.

You are about to leave Sanofi Campus website.

You are now leaving this site to visit a partner website.

Thank you for visiting COPD Sanofi Campus.

Welcome to COPD Sanofi Campus.

This website is for US healthcare professionals only.

Welcome to COPD Sanofi Campus

Welcome to CSU Sanofi Campus

Please refresh the page to access the content

Sorry, something went wrong

We're usually a treasure chest of knowledge, but we couldn't find what you're looking for.

We were unable to find what you're searching for

Sanofi does not review or control the content of non-Sanofi websites. 
MAT-US-2405606-v1.0-06/2024

You are about to leave Campus.sanofi/uk.

Images from <a>iStockphoto.com</a>, Fotolia.de, <c>gettyimages.de</c>, <d>pexels.com</d> and <e>photocase.de</e> were used for our websites.

Thank you for registering. Before we get started, we need to confirm your email address to ensure that we have the correct information.

Please follow these steps to complete your registration:

Would you like to receive future text messages about Beyfortus updates?

Sanofi is here to help support your patients, their families, and caregivers. For more information regarding Beyfortus®, call <a.callPhoneNumberBeyfortus>1-855-BEYFORTUS (1-855-239-3678)</a.callPhoneNumberBeyfortus> or sign up below to receive the latest updates via email or text. All fields are required.

Would you like to learn more about Beyfortus® (nirsevimab-alip) 50 mg and 100 mg injection? Leave us your contact details, and a Sanofi representative will be in touch. All fields are required.

Would you also like to receive future messages and updates about Beyfortus?

Do you want to participate in the Beyfortus Reservation Program?

What information are you interested in learning more about? (Optional)

Are you enrolled in REMS?

Request a visit from your local ALPROLIX representative to learn more. Call <a.callPhoneNumberAltuviiio>1-800-745-4447</a.callPhoneNumberAltuviiio>, Option 5, or complete the form below. The information you provide will be maintained in accordance with our <a.usPrivacyPolicy>Privacy Policy</a.usPrivacyPolicy>. All fields are required.

Request a visit from your local ALTUVIIIO representative to learn more. Call <a.callPhoneNumberAltuviiio>1-800-745-4447</a.callPhoneNumberAltuviiio>, Option 5, or complete the form below. The information you provide will be maintained in accordance with our <a.usPrivacyPolicy>Privacy Policy</a.usPrivacyPolicy>. All fields are required.

Request a visit from your local QFITLIA representative to learn more. Call <a.callPhoneNumberAltuviiio>1-800-745-4447</a.callPhoneNumberAltuviiio>, Option 5, or complete the form below. The information you provide will be maintained in accordance with our <a.usPrivacyPolicy>Privacy Policy</a.usPrivacyPolicy>. All fields are required.

Sign up to schedule an office visit with your ALPROLIX® Representative or receive updates about ALPROLIX. Please complete the form below. The information you provide will be maintained in accordance with our <a.usPrivacyPolicy>Privacy Policy</a.usPrivacyPolicy>. All fields are required.

Sign up to schedule an office visit with your local Sanofi representative and/or to receive updates about Qfitlia. Please complete the form below. The information you provide will be maintained in accordance with our <a.usPrivacyPolicy>Privacy Policy</a.usPrivacyPolicy>. All fields are required (unless otherwise specified).

This site is intended for healthcare professionals and relevant for HCPs.  It contains information on Sanofi medicines, educational resources, and promotional contents.  By entering this site, you are confirming that you are a healthcare professional.  

MAT-US-2405606-v1.0-06/2024

Welcome to Sanofi Campus US

Welcome to ITP Sanofi Campus

This content is only available to registered users. Please sign in or register to view this content.

Please Sign In

Email verification

You're seeing a preview of the portal. Clear your cookies (by closing your browser window for example) to go back to public mode.

We've updated our privacy notice to better protect your data and enhance your experience. Please take a moment to review the changes by <privacyNewTab>clicking here</privacyNewTab>. Your privary matters for us. Please click on continue to confirm you have read the new privacy notice.

Privacy Notice Update

Communication consent

My consents

Password

Confirm password

{resultsCount, plural, one {result} other {results}}

Please log in to access to the results

You need to sign-in to your account in order to access medical content.

Please Log In

To access the results, please register in under 1 minute

You are now leaving the Sanofi content section of our site and entering the external medical bibliographic search content section.

You are entering to the External Scientific Content Site

You are now leaving the external medical bibliographic search section of our site and entering the Sanofi content section.

You are entering to Sanofi Content Site

You are about to leave the T1D website

Welcome to the T1D Step Ahead Sanofi website

Enjoy more exclusive content by registering today

One minute to ignite new thinking in COPD

Latest COPD articles

Blood Eosinophils as a Biomarker in Patients with COPD

Understanding and Managing COPD Exacerbations

Comprehensive Guide to COPD Symptoms: Dyspnea, Chronic Cough, and More