{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:57:19Z","timestamp":1788177439271,"version":"build-2803163510"},"reference-count":27,"publisher":"European Respiratory Society (ERS)","issue":"5","license":[{"start":{"date-parts":[[2020,2,27]],"date-time":"2020-02-27T00:00:00Z","timestamp":1582761600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.ersjournals.com\/user-licence"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["NIHR Manchester Biomedical Research Centre (BRC)"],"award-info":[{"award-number":["NIHR Manchester Biomedical Research Centre (BRC)"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2020,2,17]]},"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:p>There is an emerging role for blood eosinophil count (EOS) as a biomarker to guide inhaled corticosteroid (ICS) therapy in COPD. Since ICS administration could influence EOS, we hypothesised that change in EOS following treatment with ICS may predict outcomes of long-term therapy.<\/jats:p><jats:p>In a<jats:italic>post hoc<\/jats:italic>analysis of ISOLDE, a 3-year, double-blind trial comparing 500\u2005\u00b5g fluticasone propionate twice daily with placebo in 751 patients with moderate-to-severe COPD, we evaluated whether the initial changes in EOS during ICS treatment were predictive of ICS treatment response.<\/jats:p><jats:p>EOS change within 1\u2005year after the introduction of ICS was strongly predictive of treatment response. A suppressed EOS was associated with treatment effect. Characteristically, in patients with EOS suppression of \u2265200\u2005cells\u00b7\u03bcL<jats:sup>\u22121<\/jats:sup>, ICS use was associated with a decelerated rate of decline of forced expiratory volume in 1\u2005s (FEV<jats:sub>1<\/jats:sub>), by 32\u2005mL\u00b7year<jats:sup>\u22121<\/jats:sup>, and a 30% reduction in the exacerbation rate. In contrast, in patients experiencing an increase in EOS of \u2265200\u2005cells\u00b7\u03bcL<jats:sup>\u22121<\/jats:sup>, ICS use was associated with an accelerated rate of decline of FEV<jats:sub>1<\/jats:sub>, by 37\u2005mL\u00b7year<jats:sup>\u22121<\/jats:sup>and an 80% increase in the exacerbation rate (p&lt;0.0001). EOS change was not predictive of clinical response with regards to health status evaluated using the St George's Respiratory Questionnaire.<\/jats:p><jats:p>These findings suggest that EOS change after ICS administration may predict clinical response to ICS therapy in patients with moderate-to-severe COPD at risk of exacerbations. ICS administration may be associated with more frequent exacerbations and an accelerated lung function decline in the 20% of patients in whom EOS increases after the administration of ICS. These hypothesis-generating observations will need validation in prospectively designed studies.<\/jats:p><jats:p>The ISOLDE trial was conducted before the ICJME recommended a prospective registration of RCT protocols.<\/jats:p>","DOI":"10.1183\/13993003.02119-2019","type":"journal-article","created":{"date-parts":[[2020,2,27]],"date-time":"2020-02-27T13:25:25Z","timestamp":1582809925000},"page":"1902119","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":49,"title":["Change in blood eosinophils following treatment with inhaled corticosteroids may predict long-term clinical response in COPD"],"prefix":"10.1183","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4675-9616","authenticated-orcid":false,"given":"Alexander G.","family":"Mathioudakis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andras","family":"Bikov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Foden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3494-4363","authenticated-orcid":false,"given":"Lies","family":"Lahousse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7021-8505","authenticated-orcid":false,"given":"Guy","family":"Brusselle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dave","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6355-6362","authenticated-orcid":false,"given":"J\u00f8rgen","family":"Vestbo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2020,2,27]]},"reference":[{"key":"2024102101253747000_55.5.1902119.1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00214-2017"},{"key":"2024102101253747000_55.5.1902119.2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01359-2015"},{"key":"2024102101253747000_55.5.1902119.3","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00193908"},{"key":"2024102101253747000_55.5.1902119.4","first-page":"CD010115","article-title":"Inhaled steroids and risk of pneumonia for chronic obstructive pulmonary disease","volume":"3","author":"Kew","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"2024102101253747000_55.5.1902119.5","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2004.032516"},{"key":"2024102101253747000_55.5.1902119.6","doi-asserted-by":"crossref","first-page":"15076","DOI":"10.1038\/nrdp.2015.76","article-title":"Chronic obstructive pulmonary disease","volume":"1","author":"Barnes","year":"2015","journal-title":"Nat Rev Dis Primers"},{"key":"2024102101253747000_55.5.1902119.7","doi-asserted-by":"publisher","DOI":"10.1111\/resp.13312"},{"key":"2024102101253747000_55.5.1902119.8","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01370-2015"},{"key":"2024102101253747000_55.5.1902119.9","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2015-207021"},{"key":"2024102101253747000_55.5.1902119.10","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201502-0235LE"},{"key":"2024102101253747000_55.5.1902119.11","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/S2213-2600(15)00106-X","article-title":"Blood eosinophil counts, exacerbations, and response to the addition of inhaled fluticasone furoate to vilanterol in patients with chronic obstructive pulmonary disease: a secondary analysis of data from two parallel randomised controlled trials","volume":"3","author":"Pascoe","year":"2015","journal-title":"Lancet Respir Med"},{"key":"2024102101253747000_55.5.1902119.12","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/S2213-2600(16)00100-4","article-title":"Blood eosinophil count and exacerbations in severe chronic obstructive pulmonary disease after withdrawal of inhaled corticosteroids: a post-hoc analysis of the WISDOM trial","volume":"4","author":"Watz","year":"2016","journal-title":"Lancet Respir Med"},{"key":"2024102101253747000_55.5.1902119.13","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/S2213-2600(18)30006-7","article-title":"Predictors of exacerbation risk and response to budesonide in patients with chronic obstructive pulmonary disease: a post-hoc analysis of three randomised trials","volume":"6","author":"Bafadhel","year":"2018","journal-title":"Lancet Respir Med"},{"key":"2024102101253747000_55.5.1902119.14","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1164\/rccm.201701-0193OC","article-title":"Blood eosinophils and response to maintenance chronic obstructive pulmonary disease treatment. Data from the FLAME trial","volume":"195","author":"Roche","year":"2017","journal-title":"Am J Respir Crit Care Med"},{"key":"2024102101253747000_55.5.1902119.15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1713901"},{"key":"2024102101253747000_55.5.1902119.16","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30206-X"},{"key":"2024102101253747000_55.5.1902119.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30188-5"},{"key":"2024102101253747000_55.5.1902119.18","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00164-2019"},{"key":"2024102101253747000_55.5.1902119.19","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.159.1.9706006"},{"key":"2024102101253747000_55.5.1902119.20","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/145.3.669"},{"key":"2024102101253747000_55.5.1902119.21","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)11679-5"},{"key":"2024102101253747000_55.5.1902119.22","doi-asserted-by":"publisher","DOI":"10.1016\/0091-6749(94)90154-6"},{"key":"2024102101253747000_55.5.1902119.23","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02872-5"},{"key":"2024102101253747000_55.5.1902119.24","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00146306"},{"key":"2024102101253747000_55.5.1902119.25","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7245.1297"},{"key":"2024102101253747000_55.5.1902119.26","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/145.6.1321"},{"key":"2024102101253747000_55.5.1902119.27","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2012-202878"}],"container-title":["European Respiratory Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/13993003.02119-2019","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T07:29:15Z","timestamp":1740382155000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/13993003.02119-2019"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,27]]},"references-count":27,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,5,27]]},"published-print":{"date-parts":[[2020,5]]}},"alternative-id":["10.1183\/13993003.02119-2019"],"URL":"https:\/\/doi.org\/10.1183\/13993003.02119-2019","relation":{},"ISSN":["0903-1936","1399-3003"],"issn-type":[{"value":"0903-1936","type":"print"},{"value":"1399-3003","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,27]]}}}