{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T08:17:22Z","timestamp":1787991442214,"version":"build-2784847793"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:00:00Z","timestamp":1787961600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:00:00Z","timestamp":1787961600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Lung"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Inhaled corticosteroids (ICS) are recommended for select patients with chronic obstructive pulmonary disease (COPD) based on exacerbation history and blood eosinophil counts. Prior studies suggest that ICS are frequently prescribed outside of guideline-based criteria, and eosinophil testing is inconsistently performed in clinical practice. This study evaluated adherence to Global Initiative for Chronic Obstructive Lung Disease (GOLD) eosinophil criteria for ICS prescribing and associated clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective observational cohort study included adults with COPD receiving care within Cleveland Clinic outpatient practices in Ohio who were newly initiated on an ICS-containing regimen between January 1, 2021, and July 31, 2023. Patients were classified based on whether ICS prescribing aligned with GOLD eosinophil criteria. Outcomes included adherence to GOLD eosinophil recommendations for ICS use, pneumonia incidence, ICS de-escalation, and predictors of prescribing outside guideline-based criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 688 patients were included. Most patients received ICS outside of GOLD eosinophil criteria (589\/688, 86%). Baseline eosinophil testing was performed in 102 patients (15%). Pneumonia incidence was similar among patients prescribed ICS outside versus within guideline-based criteria (15% vs. 16%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.686). ICS de-escalation was uncommon overall (7%) and occurred at similar rates between groups. A history of prior exacerbations was associated with prescribing within guideline-based indications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ICS prescribing frequently occurred outside of GOLD eosinophil criteria, with limited utilization of eosinophil testing in clinical practice. Clinical outcomes were similar regardless of guideline alignment, and ICS de-escalation was infrequent. These findings highlight opportunities to improve integration of eosinophil-guided decision-making into COPD management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00408-026-00930-x","type":"journal-article","created":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T08:12:35Z","timestamp":1787991155000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing Inhaled Corticosteroid Prescribing in COPD: Evaluating the Impact of Eosinophil Testing on Clinical Outcomes"],"prefix":"10.1007","volume":"204","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5573-1407","authenticated-orcid":false,"given":"Jared","family":"Hester","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3103-2545","authenticated-orcid":false,"given":"David","family":"Whipkey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6436-1919","authenticated-orcid":false,"given":"James","family":"Ferrell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,29]]},"reference":[{"key":"930_CR1","unstructured":"Global Initiative for Chronic Obstructive Lung Disease (2026) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2026 report. GOLD. https:\/\/goldcopd.org\/2026-gold-report\/"},{"key":"930_CR2","unstructured":"Global Initiative for Chronic Obstructive Lung Disease (2025) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2025 report. GOLD. https:\/\/goldcopd.org\/2025-gold-report\/"},{"key":"930_CR3","doi-asserted-by":"publisher","DOI":"10.1038\/s41533-023-00347-6","volume":"33","author":"JK Quint","year":"2023","unstructured":"Quint JK, Ariel A, Barnes PJ (2023) Rational use of inhaled corticosteroids for the treatment of COPD. NPJ Prim Care Respir Med 33:27. https:\/\/doi.org\/10.1038\/s41533-023-00347-6","journal-title":"NPJ Prim Care Respir Med"},{"key":"930_CR4","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-021-01651-w","volume":"22","author":"O Savran","year":"2021","unstructured":"Savran O, Godtfredsen N, S\u00f8rensen T, Jensen C, Ulrik CS (2021) COPD patients prescribed inhaled corticosteroid in primary care: time for re-assessment based on exacerbation rate and blood eosinophils? Respir Res 22:54. https:\/\/doi.org\/10.1186\/s12931-021-01651-w","journal-title":"Respir Res"},{"key":"930_CR5","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2022.106880","volume":"198","author":"DA Dalin","year":"2022","unstructured":"Dalin DA, L\u00f8kke A, Kristiansen P et al (2022) A systematic review of blood eosinophils and continued treatment with inhaled corticosteroids in patients with COPD. Respir Med 198:106880. https:\/\/doi.org\/10.1016\/j.rmed.2022.106880","journal-title":"Respir Med"},{"key":"930_CR6","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00606-2021","volume":"8","author":"HF Ashdown","year":"2022","unstructured":"Ashdown HF, Smith M, McFadden E, Pavord ID, Butler CC, Bafadhel M (2022) Blood eosinophils to guide inhaled maintenance therapy in a primary care COPD population. ERJ Open Res 8:00606-2021. https:\/\/doi.org\/10.1183\/23120541.00606-2021","journal-title":"ERJ Open Res"},{"issue":"1","key":"930_CR7","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1056\/NEJMoa1916046","volume":"383","author":"KF Rabe","year":"2020","unstructured":"Rabe KF, Martinez FJ, Ferguson GT et al (2020) Triple inhaled therapy at two glucocorticoid doses in moderate-to-very-severe COPD. N Engl J Med 383(1):35\u201348. https:\/\/doi.org\/10.1056\/NEJMoa1916046","journal-title":"N Engl J Med"},{"key":"930_CR8","doi-asserted-by":"publisher","first-page":"1671","DOI":"10.1056\/NEJMoa1713901","volume":"378","author":"DA Lipson","year":"2018","unstructured":"Lipson DA, Barnhart F, Brealey N et al (2018) Once-daily single-inhaler triple versus dual therapy in patients with COPD. N Engl J Med 378:1671\u20131680. https:\/\/doi.org\/10.1056\/NEJMoa1713901","journal-title":"N Engl J Med"},{"key":"930_CR9","unstructured":"Global Initiative for Chronic Obstructive Lung Disease (2019) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2019 report. 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J Med Virol 94:2357\u20132359. https:\/\/doi.org\/10.1002\/jmv.27653","journal-title":"J Med Virol"}],"container-title":["Lung"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00408-026-00930-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00408-026-00930-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00408-026-00930-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T08:12:37Z","timestamp":1787991157000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00408-026-00930-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,29]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["930"],"URL":"https:\/\/doi.org\/10.1007\/s00408-026-00930-x","relation":{},"ISSN":["1432-1750"],"issn-type":[{"value":"1432-1750","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,29]]},"assertion":[{"value":"17 June 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors have no relevant financial or non-financial interests to disclose.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was reviewed by the Cleveland Clinic Institutional Review Board and determined to be exempt from full review (IRB No. 25\u2013919).","order":2,"name":"Ethics","label":"Ethical Approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Consent to Participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":4,"name":"Ethics","label":"Consent for Publication","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"63"}}