S26 Severe hospitalised exacerbations of COPD with an eosinophilic phenotype have favourable outcomes with prednisolone therapy: sub-analysis from a prospective multi-centre randomised control trial

Abstract

Introduction In moderate exacerbations of COPD, patients withthe eosinophilic phenotype (>2% of the total leukocyte count) havebetter outcomes with prednisolone. However, it remains unclearwhether patients with severe exacerbations displaying theeosinophilic phenotype have accentuated recovery followingcorticosteroid therapy compared to non-eosinophilic COPDexacerbations. Aim Measure the incidence of eosinophilic andnon-eosinophilic severe exacerbations of COPD, from a largeprospective enhanced recovery multi-centre randomised control trialand investigate severity and recovery between these groups. MethodsCOPD patients entering the programme delivered immediately onhospitalisation for an acute exacerbation of chronic respiratorydisease to improve long term health outcomes (clinical trialregistration ISRCTN05557928) were analysed using admission details,length of stay and proceeding exacerbation history. All patientswere dichotomised into eosinophilic (>200 x106 cells/mL and/or >2%of the total leukocyte count) and non-eosinophilic. CRP was measuredon admission. Results There were 243 COPD patients (117 males)identified. The mean (range) age was 71 years (45-93) and themajority of patients (55%) had been hospitalised for an exacerbationof COPD in the previous 12 months. Of all exacerbations, theinpatient mortality rate was 3% (median time to death 12 days, range9-16) and approximately 90% received both antibiotic andcorticosteroid treatment. The incidence of an eosinophilicexacerbation was 25% (median absolute eosinophil count 100x106cells/ml; range 10 to 1500). In patients with eosinophilicexacerbations compared to non-eosinophilic exacerbations the median(IQR) CRP concentration was significantly lower (12mg/L (5-47) vs.55mg/L (18-139), p < 0.001); and the presence of an elevatedeosinophil count and elevated CRP (>200 x106 eosinophils/mL andCRP>50mg/L) occurred in only 5% of all exacerbations. The length ofstay was significantly shorter in patients with eosinophilicexacerbations compared to non-eosinophilic exacerbations (mean(range) 5.0 (1-19) vs. 6.5 (1-33), p = 0.015). The severity of theindex exacerbation or the rate of exacerbations or hospitalisationsin the following 12 months was not statistically significant betweengroups. Conclusions In severe hospitalised exacerbations of COPD, aproportion have an associated eosinophilic phenotype. Theseexacerbations are usually not associated with an elevated CRP.Eosinophilic exacerbations have better responses to oralcorticosteroids with shortened length of stay.