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 It has been found that up to 37% of COPD patients show indication of type 2 inflammation.2-5&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/">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.

CHRONIC-OBSTRUCTIVE-PULMONARY-DISEASE-(COPD)

Blood Eosinophils as a Biomarker in Patients with COPD

<h2>Learn more on how to assess these goals below&nbsp;</h2>
How to evaluate success in achieving treatment goals?
Success in managing chronic obstructive pulmonary disease (COPD) is multifaceted and can be measured by reduction in symptom severity and disease progression, clinically meaningful reductions in exacerbations, significant improvement in lung function, improved exercise tolerance and an increase in a patient’s quality of life (QoL). Treatment success requires a continuous cycle of assessment, treatment adjustment, and a review of response.1 Evidence-based metrics can be used to gauge outcomes in COPD patients and provide a structured way to assess the effectiveness of treatments and guide clinical decisions towards improving the lives of patients with COPD as discussed in the following sections.
What is the impact of exacerbations on patients’ disease trajectory?
Frequent exacerbations are associated with poor health status, morbidity, and mortality. They can result in a decline in lung function and frequent hospitalizations.1,2 Minimizing the negative impact of ongoing exacerbations and reducing the number and severity of exacerbations is critical to COPD management.2&nbsp;Successful treatment is often reflected in fewer hospitalizations due to exacerbations and a better control of symptoms.2,3 
To learn more about the impact of exacerbations, read this article <a href="https://pro.campus.sanofi/copd/articles/the-impact-of-exacerbations-in-copd" style="color:#69a020; text-decoration:underline">The Impact of exacerbations in COPD | Campus Sanofi</a>.
&nbsp;
How is lung function assessed in patients with COPD?
Rapidly declining lung function in patients with COPD results in impaired health status and increases risk of mortality.<a name="_Hlk169000230">4</a> Assessment of lung function by spirometry, particularly the Forced Expiratory Volume in 1 second (FEV1), plays an important role in determining the severity of COPD and guiding treatment.4 A slower decline in FEV1 over time is indicative of successful disease management.4
&nbsp;
How can symptoms and their impact be assessed?
Symptoms impact the daily lives of patients by significantly influencing physical activity, health status and QoL.2 COPD treatment guidelines recommend using standardized multidimensional measures, COPD assessment test (CAT), modified Medical Research Council (mMRC) dyspnea scale and, St. George’s Respiratory Questionnaire (SGRQ), for assessing health status and QoL.1,5
&nbsp;
Which symptoms can be scored on CAT?
CAT is simple and easy to administer and scores 8 functional parameters — cough, phlegm, chest tightness, breathlessness while climbing up a hill or flight of stairs, activity limitation at home, confidence leaving home, sleep, and energy. These 8 parameters are scored on a scale of 1 to 5, with a total score of 40.1,5 The CAT score provides a measure of the impact of disease on patient’s daily life. A CAT score of 5 is the upper limit of normal in healthy non-smoking individuals.6 A worsening CAT score in COPD patients may suggest unreported exacerbations by patients, discontinuation of medications, ineffective intake of treatment, rapid disease progression, or the need for specialist intervention.<a name="_Hlk169000349">6</a>
CAT™ Assessment1,7

What is the use of mMRC questionnaire in symptom assessment?
Dyspnea shows poor association with objective evaluation of lung function, exercise capacity, and other outcomes as it is a subjective metric.4 The mMRC questionnaire is used to assess the severity of dyspnea by grading its impact on daily activities on a scale of 0 to 4.2,8 A decrease in mMRC scores indicates successful alleviation of the symptoms.8
How does St. George’s Respiratory Questionnaire (SGRQ) help physicians assess COPD patients?
Health Status and QoL are vital outcome parameters that should be assessed in patients with COPD. Perceptions about the impact of symptoms on patient’s QoL may considerably vary between HCPs and their patients.2,9 Tools like the SGRQ, encompassing domains of symptoms, activity, and psychosocial impact, evaluate the effects of COPD on respiratory health and daily life.4,10,11 With a maximum total score of 100 points, COPD treatment guidelines recommend regular symptomatic treatment in case of SGRQ score ≥25.1,4 A lower score on SGRQ reflects improved health status. A minimum change in SGRQ score of 4 units is considered as clinically relevant.10

What other parameters should be monitored to evaluate treatment success? 
According to COPD treatment guidelines, walking tests can be used to evaluate disability and risk of mortality.1 Reduced exercise capacity is associated with disease progression, increasing predisposition to poor QoL, hospitalization and mortality.1 A six-minute walk test (6MWT) can be performed to assess exercise tolerance.12 An increase in the distance covered during the 6MWT signifies enhanced physical fitness, a key goal to reduce symptoms.

This article provides pulmonologists with essential insights into evaluating COPD management. It delves into the multifaceted approach required to measure success, including reducing symptom severity, preventing exacerbations, improving lung function, enhancing exercise tolerance, and boosting the quality of life. By employing standardized assessment tools such as the COPD Assessment Test (CAT), modified Medical Research Council (mMRC) dyspnea scale, and St. George’s Respiratory Questionnaire (SGRQ), clinicians can accurately gauge treatment effectiveness. Additionally, the article highlights the importance of continuous assessment and adjustment in managing COPD, ensuring better patient outcomes.

Key tools to measure the success of COPD management

<h1>Chronic Obstructive Pulmonary Disease (COPD) is a major health concern globally, with a significant impact on the quality of life and life expectancy of affected individuals. Surya Bhatt, a distinguished professor of medicine at the University of Alabama at Birmingham and a COPD researcher, provides valuable insights into the progression and management of this disease. This article will delve into key aspects of COPD exacerbations, drawing on the expertise of Dr. Bhatt to enhance our understanding.</h1>

The burden and Risk of Exacerbations in COPD according to Dr. Surya Bhatt

My name is Surya Bhatt. I'm a professor of medicine at the University of Alabama at Birmingham, and I'm a COPD researcher. This talk is sponsored by Sanofi and Regeneron, and you won't get any CME credit. One of the other things that's very important in COPD is acute exacerbations. And these are not just an inconvenience but are associated with significant disease progression. Now there's plenty of data to suggest that these exacerbations are associated with lung function decline. They're commonly caused by infections such as viruses and bacterial infections sometimes due to environmental pollution and occupational exposures. Regardless of the cause, the severity is determined by where they're treated, which is not ideal. But if they manage to adjust steroids and antibiotics at home, that classifies as a moderate exacerbation. But if it's severe enough to end up in the hospital, and then that causes a severe exacerbation and people will suffer from exacerbations, have a faster rate of lung function decline than those who do not have exacerbations at all. And here on the right is data from the COPD gene study where they looked at the FEV one decline by exacerbation or the frequency of exacerbations.
&nbsp;
And especially for severe exacerbations and especially for those with milder disease who have more lung function to lose the effect can be quite dramatic. The FEV even decline can be up to 87mm for a severe exacerbation in world stage one, for example. And as you can imagine, if you get 4 or 5 exacerbations, you can lose up to a half a meter of fev1 over the next 4 to 5 years. The severe exacerbations appear to be sentinel events in the course of the COPD patients. When somebody gets a first exacerbation it seems like it begets more exacerbations. In a retrospective study by Sammy Sosa of about 75,000 patients in Canada. He modeled the severe exacerbation frequency and found that the usual median interval between a first and a second exacerbation is about five and a half years, and then the exacerbations happen at progressively shorter intervals to the point that by about the 10th exacerbation the median interval is about four months. So you can imagine a patient within a few years settling into a pattern of 3 to 4 exacerbations needing hospitalization in a single year.
&nbsp;
And this is not without consequence. These kind of exacerbations can have an effect on mortality. The hazards of mortality is about twice. If you get two severe exacerbations as opposed to one severe exacerbation. And the hazards of mortality is five fold. If you get ten exacerbations as opposed to one severe exacerbation. So there's almost a monotonic increase in the hazards with increasing severe exacerbation frequency. And the curve on the right shows your risk of dying after a single severe exacerbation requiring hospitalization. So the mortality within one year is about 25%, and the mortality within four years after discharge after the first severe exacerbation is 50%.

Read podcast transcript

<h2>What is COPD?</h2>
COPD is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production, and wheezing. It is typically caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. Individuals with COPD are at increased risk of developing heart disease, lung cancer, and a variety of other conditions.

<h2>The Critical Role of Exacerbations in COPD Progression</h2>
Dr. Bhatt emphasizes that acute exacerbations of COPD are not merely inconveniences but are pivotal events that significantly influence the course of the disease. "One of the other things that's very important in COPD is acute exacerbations. And these are not just an inconvenience but are associated with significant disease progression," he states. Exacerbations are typically triggered by infections such as viruses and bacterial infections or by environmental pollution and occupational exposures.
<h3>Impact on Lung Function</h3>
Exacerbations have a profound impact on lung function, with data suggesting a link between exacerbations and accelerated lung function decline. Dr. Bhatt notes, "There's plenty of data to suggest that these exacerbations are associated with lung function decline." This decline is more severe in the case of frequent exacerbations. For instance, he cites the COPD Gene study, which shows how the frequency of exacerbations correlates with the rate of FEV1 decline—a measure of lung function.

<h3>Severity and Treatment</h3>
The severity of exacerbations can vary, significantly affecting treatment approaches and outcomes. "But if they manage to adjust steroids and antibiotics at home, that classifies as a moderate exacerbation. But if it's severe enough to end up in the hospital, then that causes a severe exacerbation," explains Dr. Bhatt. The distinction between moderate and severe exacerbations is crucial as it determines the immediate treatment protocol and the long-term management strategy.

<h2>The Cascading Effects of Severe Exacerbations</h2>
Severe exacerbations are particularly concerning due to their cascading effects on health. Dr. Bhatt discusses a study by Sammy Sosa, which modeled severe exacerbation frequency among approximately 75,000 patients in Canada. The study found that the interval between exacerbations tends to decrease over time, indicating a worsening pattern of the disease. "When somebody gets a first exacerbation, it seems like it begets more exacerbations," he explains.
<h3>Mortality Risks</h3>
The mortality risks associated with severe exacerbations are stark. Dr. Bhatt highlights, "The hazards of mortality is about twice if you get two severe exacerbations as opposed to one severe exacerbation. And the hazards of mortality is fivefold if you get ten exacerbations as opposed to one severe exacerbation." Furthermore, the risk of dying within one year of a severe exacerbation requiring hospitalization is about 25%, which increases to 50% within four years after discharge.

<h2>In Summary</h2>
The insights provided by Dr. Surya Bhatt illuminate the severe implications of COPD exacerbations. Understanding the triggers, frequency, and severity of these exacerbations is crucial for managing COPD effectively. As research continues to evolve, it is essential for healthcare providers to stay informed about the best practices for treating and managing exacerbations to improve the quality of life for COPD patients. Additionally, preventative strategies, including smoking cessation and reducing exposure to pollutants, remain key components of COPD management. Through a comprehensive approach that includes both prevention and effective exacerbation management, the impact of COPD can be significantly mitigated.

Chronic Obstructive Pulmonary Disease (COPD) is a major health concern globally, with a significant impact on the quality of life and life expectancy of affected individuals. Surya Bhatt, a distinguished professor of medicine at the University of Alabama at Birmingham and a COPD researcher, provides valuable insights into the progression and management of this disease. This article will delve into key aspects of COPD exacerbations, drawing on the expertise of Dr. Bhatt to enhance our understanding.

What if you could identify higher-risk patients?&nbsp;&nbsp;
A deeper look at the inflammation behind exacerbations could ignite new thinking in COPD. Look for blood eosinophils, a biomarker of COPD with Type 2 Inflammation, which may help you identify those patients at increased risk of exacerbations.
Watch the video below to better understand exacerbations in COPD and better identify patients at risk.&nbsp;&nbsp;&nbsp;

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

Ignite new thinking in COPD -&nbsp;COPD, chronic obstructive pulmonary disease
In patients with COPD, exacerbations may :&nbsp;
<ul>
 <li>Increase the risk of another&nbsp;1</li>
 <li>Accelerate lung function decline&nbsp;2</li>
 <li>Increase morbidity and mortality risk&nbsp;1,3-6</li>
</ul>
Different types of chronic inflammation have an important role in COPD&nbsp;7-15 
 Type 2 inflammation and beyond type 2 inflammation 
 Identifying COPD patients with type 2 inflammation may help determine those at increased risk of exacerbations 16 
 Look for blood eosinophils, a biomarker of COPD with type 2 inflammation 17,18, a, b 
 EOS ≥ 300 cells/ μL à 32% increased risk of COPD exacerbations 16a,b 
 Understanding type 2 inflammation in COPD may shed light on why some patients continue to experience exacerbations
a Results from an observational analysis of 1553 patients with GOLD spirometry grade 2-4 COPD evaluating the relationship between blood eosinophil count and COPD exacerbation risk. b Stratified analysis confirmed that increased exacerbation risk was driven by subjects with a history of frequent exacerbations, defined as ≥2 exacerbations per year.

Read video transcript

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

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One minute to ignite new thinking in COPD

Latest COPD articles

Blood Eosinophils as a Biomarker in Patients with COPD

Key tools to measure the success of COPD management

The burden and Risk of Exacerbations in COPD according to Dr. Surya Bhatt