As part of our ongoing seminar series, the Centre of Excellence in Severe Asthma hosted Prof. Ian Pavord for a webinar on “Biomarkers of Inhaled Corticosteroid Respond in COPD” on 20 June 2016.
Presentation Summary:
Corticosteroid treatment is effective at reducing exacerbation rates in people with COPD. The benefit of treatment is balanced by an increased risk of pneumonias and steroid-associated side effects. Biomarkers have been proposed to identify the patients most likely to respond to steroid treatment.
Biomarkers can provide information about the mechanisms underlying disease in individual patients. Eosinophil numbers are increased in a subset of COPD patients. Increased sputum eosinophil numbers are associated with a better response to steroid treatment.
Blood eosinophil counts are more readily accessible than sputum assessment. Blood eosinophil counts are a useful biomarker of COPD exacerbations. Increased blood eosinophil counts also predict response steroid treatment.
A “treatable traits” approach to treating airways disease is proposed. Treatment should be targeted to the disease mechanisms identified in each patient.
Key Points:
- Corticosteroids are primarily used as a risk-reduction strategy in COPD treatment
- Inhaled corticosteroid (ICS) treatment reduces COPD exacerbations, with no effect on decline in lung function (Burge et al BMJ 2000)
- Corticosteroid treatment also increases rates of pneumonia (Calverley et al. NEJM 2007)
- GOLD Guidelines (2011) recommend use of corticosteroids for risk-reduction, in COPD patients with previous exacerbation history or airflow limitation
- There is increasing concern about the costs of treatments and assessing cost/benefit for healthcare expenditures
- Triple therapy for COPD is of questionable cost/benefit value
- There is increasing recognition of adverse effects of long-term corticosteroid use
- New insights into the mechanisms regulating COPD pathogenesis may provide a more targeted approach for treatment
- Sputum eosinophil counts are increased in a subset of COPD patients
- Higher sputum eosinophil numbers are associated with a better response to steroid therapy
- Treatment where steroid dose is guided by sputum eosinophil number reduces exacerbations for COPD patients
- Availability of sputum inflammation assessment is limited in most clinical settings
- Blood eosinophil count is a useful biomarker of eosinophilic exacerbations
- ICS treatment reduces exacerbation rates in COPD patients with higher blood eosinophil counts (Pascoe Lancet Resp Med 2015)
- Withdrawal of ICS treatment is associated with increased exacerbation risk only in patients with elevated blood eosinophil counts (Watz Lancet Resp Med 2016)
- Pneumonia risk following ICS treatment is independent of blood eosinophil counts
- Additional biomarkers of Type-2 inflammation include fractional exhaled nitric oxide (FeNO) and periostin
- In COPD, FeNO level does not correlate well with sputum eosinophil numbers and smoking has variable effects on FeNO level
- There is no correlation between periostin and sputum eosinophil counts in COPD
- A “treatable traits” management approach should be applied for airways disease based on the type of airways inflammation rather than disease label (e.g. COPD)
- Symptoms caused by airflow limitation should be treated using bronchodilators
- Exacerbation risk associated with eosinophilic inflammation should be treated using ICS
- This approach could support a more efficient use of existing treatment strategies
About Prof. Ian Pavord:
Prof. Ian Pavord is Professor of Respiratory Medicine at the University of Oxford and Honorary Consultant Physician at the Oxford University Hospitals.
He has published 260 scientific papers, including three of the 20 most cited papers in the field in the last 10 years. He has an H-index of 65. His main contribution has been to develop new methods to assess and treat airway inflammation and airway diseases.
He has been joint Chief Medical Advisor to Asthma UK since May 2008 and joint Editor of Thorax since 2010.
Prof. Pavord’s travel was supported by Menarini.
