Study on the correlation between EOS and clinical features and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

CHEN Xueer ¹ , HUANG Zhong ² ,  LU Xianling ¹

1. Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Shihezi University, Xinjiang832000, P.R.China;
2. Emergency Medical Center of the First Affiliated Hospital of Shihezi University, Xinjiang832000, P.R.China;

Corresponding author：

LU Xianling, Email: luxianlingmary@163.com

Keywords：

Acute exacerbation of chronic obstructive pulmonary disease; Eosinophils; Inhaled corticosteroids; Lung function

DOI：

10.7507/1671-6205.202411020

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective The purpose of this study was to explore the correlation between peripheral blood eosinophil (EOS) count and smoking history, some inflammatory indicators, lung function, efficacy of ICS, risk of respiratory failure and chronic pulmonary heart disease, risk of acute exacerbation within 1 year, readmission rate and mortality in patients with acute exacerbation of COPD. Methods Retrospective analysis of the baseline clinical data of 816 patients with acute exacerbation of chronic obstructive pulmonary disease in the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Shihezi University from January 1,2019 to December 31,2021. The patients were divided into EOS ≥ 200 cells / μL (High Eosinophi, HE) group and EOS<200 cells / μL (low Eosinophi, LE) group according to whether the peripheral blood EOS was greater than 200 cells / μL at admission. Peripheral venous blood data (including blood eosinophil count, white blood cell count, lymphocyte percentage, neutrophil percentage), blood gas analysis value, lung function index and medication regimen of all patients were collected, and the efficacy of ICS was recorded. The patients were followed up for 1 year to observe the acute exacerbation and readmission rate, and the mortality rate was followed up for 1 year and 2 years. Results Neutrophil count, lymphocyte count and peak expiratory flow (PEF) in HE group were positively correlated with EOS value (P<0.05), and smoking was more likely to increase EOS value. HE group was more sensitive to ICS. The risk of acute exacerbation in HEA group was higher than that in LE group. ICS could reduce the rate of acute exacerbation in HE group. EOS value in LE group was inversely proportional to FEV₁ / FVC and MMEF values (P<0.05). The risk of chronic pulmonary heart disease in LE group was higher than that in HE group. The 2-year mortality rate in HE group was higher than that in LE group. Conclusions Peripheral blood EOS count is correlated with some inflammatory indicators, acute exacerbation risk, and lung function. ICS can improve the clinical symptoms and prognosis of patients with higher EOS count.

Citation： CHEN Xueer, HUANG Zhong, LU Xianling. Study on the correlation between EOS and clinical features and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease. Chinese Journal of Respiratory and Critical Care Medicine, 2025, 24(8): 548-555. doi: 10.7507/1671-6205.202411020 Copy

1.	Global Initiative for Chronic Obstructive Lung Disease (Gold). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2023 report). Fontana: GOLD, 2023.
2.	Barnes PJ. Inflammatory mechanisms in patients with chronic obstructive pulmonary disease. J Allergy Clin Immunol, 2016, 138(1): 16-27.
3.	Bafadhel M, Mckenna S, Terry S, et al. Acute exacerbations of chronic obstructive pulmonary disease: identification of biologic clusters and their biomarkers. Am J Respir Crit Care Med, 2011, 184(6): 662-671.
4.	周寅川, 荣蓉, 黄祎丹, 等. 慢性阻塞性肺疾病急性加重期患者出院后30d内再入院的影响因素分析及Nomogram模型构建. 实用心脑肺血管病杂志, 2020, 28(8): 57-63.
5.	Ronchi MC, Piragino C, Rosi E, et al. Role of sputum differential cell count in detecting airway inflammation in patients with chronic bronchial asthma or COPD. Thorax, 1996, 51(10): 1000-1004.
6.	中华医学会呼吸病学分会慢性阻塞性肺疾病学组, 中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会. 慢性阻塞性肺疾病诊治指南(2021年修订版). 中华结核和呼吸杂志, 2021, 44(3): 170-205.
7.	Singh D, Kolsum U, Brightling CE, et al. Eosinophilic inflammation in COPD: prevalence and clinical characteristics. Eur Respir J, 2014, 44(6): 1697-1700.
8.	Boulet LP, Lemière C, Archambault F, et al. Smoking and asthma: clinical and radiologic features, lung function, and airway inflammation. Chest, 2006, 129(3): 661-668.
9.	Demarche S, Schleich F, Henket M, et al. Detailed analysis of sputum and systemic inflammation in asthma phenotypes: are paucigranulocytic asthmatics really non-inflammatory? BMC Pulm Med, 2016, 16: 46.
10.	Jang AS, Park JS, Lee JH, et al. The impact of smoking on clinical and therapeutic effects in asthmatics. J Korean Med Sci, 2009, 24(2): 209-214.
11.	Wilson SJ, Ward JA, Sousa AR, et al. Severe asthma exists despite suppressed tissue inflammation: findings of the U-BIOPRED study. Eur Respir J, 2016, 48(5): 1307-1319.
12.	St-Laurent J, Bergeron C, Pagé N, et al. Influence of smoking on airway inflammation and remodelling in asthma. Clin Exp Allergy, 2008, 38(10): 1582-1589.
13.	Polosukhin VV, Richmond BW, Du RH, et al. Secretory IgA deficiency in individual small airways is associated with persistent inflammation and remodeling. Am J Respir Crit Care Med, 2017, 195(8): 1010-1021.
14.	Richmond BW, Du RH, Han W, et al. Bacterial-derived neutrophilic inflammation drives lung remodeling in a mouse model of chronic obstructive pulmonary disease. Am J Respir Cell Mol Biol, 2018, 58(6): 736-744.
15.	Lv MY, Qiang LX, Li ZH, et al. The lower the eosinophils, the stronger the inflammatory response? The relationship of different levels of eosinophils with the degree of inflammation in acute exacerbation chronic obstructive pulmonary disease (AECOPD). J Thorac Dis, 2021, 13(1): 232-243.
16.	Hastie AT, Martinez FJ, Curtis JL, et al. Association of sputum and blood eosinophil concentrations with clinical measures of COPD severity: an analysis of the SPIROMICS cohort. Lancet Respir Med, 2017, 5(12): 956-967.
17.	Weir M, Zhao H, Han MK, et al. Eosinophils in chronic obstructive pulmonary disease, the SPIROMICS cohort. American Journal of Respiratory and Critical Care Medicine, 2014, 189(A1): A5902.
18.	Macdonald MI, Osadnik CR, Bulfin L, et al. MULTI-PHACET: multidimensional clinical phenotyping of hospitalised acute COPD exacerbations. ERJ Open Res, 2021, 7(3): 00198-2021.
19.	Lu Y, Huang Y, Li J, et al. Eosinophil extracellular traps drive asthma progression through neuro-immune signals. Nat Cell Biol, 2021, 23(10): 1060-1072.
20.	Bafadhel M, Davies L, Calverley PM, et al. Blood eosinophil guided prednisolone therapy for exacerbations of COPD: a further analysis. Eur Respir J, 2014, 44(3): 789-791.
21.	Lipson DA, Barnhart F, Brealey N, et al. Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD. N Engl J Med, 2018, 378(18): 1671-1680.
22.	Papi A, Vestbo J, Fabbri L, et al. Extrafine inhaled triple therapy versus dual bronchodilator therapy in chronic obstructive pulmonary disease (TRIBUTE): a double-blind, parallel group, randomised controlled trial. Lancet, 2018, 391(10125): 1076-1084.
23.	Wedzicha JA, Calverley PM, Seemungal TA, et al. The prevention of chronic obstructive pulmonary disease exacerbations by salmeterol/fluticasone propionate or tiotropium bromide. Am J Respir Crit Care Med, 2008, 177(1): 19-26.
24.	Vedel-Krogh S, Nielsen SF, Lange P, et al. Blood eosinophils and exacerbations in chronic obstructive pulmonary disease. The Copenhagen General Population Study. Am J Respir Crit Care Med, 2016, 193(9): 965-974.
25.	Siddiqui SH, Guasconi A, Vestbo J, et al. Blood eosinophils: a biomarker of response to extrafine beclomethasone/formoterol in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2015, 192(4): 523-525.
26.	尹婧婧, 张巍, 张茗, 等. 外周血嗜酸粒细胞与老年慢性阻塞性肺疾病急性加重患者临床特征及短期预后的关系研究. 实用心脑肺血管病杂志, 2023, 31(5): 45-49.
27.	Bafadhel M, Peterson S, De Blas MA, et al. Predictors of exacerbation risk and response to budesonide in patients with chronic obstructive pulmonary disease: a post-hoc analysis of three randomised trials. Lancet Respir Med, 2018, 6(2): 117-126.
28.	Pascoe S, Locantore N, Dransfield MT, et al. 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. Lancet Respir Med, 2015, 3(6): 435-442.
29.	Couillard S, Larivée P, Courteau J, et al. Eosinophils in COPD exacerbations are associated with increased readmissions. Chest, 2017, 151(2): 366-373.

1. Global Initiative for Chronic Obstructive Lung Disease (Gold). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2023 report). Fontana: GOLD, 2023.
2. Barnes PJ. Inflammatory mechanisms in patients with chronic obstructive pulmonary disease. J Allergy Clin Immunol, 2016, 138(1): 16-27.
3. Bafadhel M, Mckenna S, Terry S, et al. Acute exacerbations of chronic obstructive pulmonary disease: identification of biologic clusters and their biomarkers. Am J Respir Crit Care Med, 2011, 184(6): 662-671.
4. 周寅川, 荣蓉, 黄祎丹, 等. 慢性阻塞性肺疾病急性加重期患者出院后30d内再入院的影响因素分析及Nomogram模型构建. 实用心脑肺血管病杂志, 2020, 28(8): 57-63.
5. Ronchi MC, Piragino C, Rosi E, et al. Role of sputum differential cell count in detecting airway inflammation in patients with chronic bronchial asthma or COPD. Thorax, 1996, 51(10): 1000-1004.
6. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组, 中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会. 慢性阻塞性肺疾病诊治指南(2021年修订版). 中华结核和呼吸杂志, 2021, 44(3): 170-205.
7. Singh D, Kolsum U, Brightling CE, et al. Eosinophilic inflammation in COPD: prevalence and clinical characteristics. Eur Respir J, 2014, 44(6): 1697-1700.
8. Boulet LP, Lemière C, Archambault F, et al. Smoking and asthma: clinical and radiologic features, lung function, and airway inflammation. Chest, 2006, 129(3): 661-668.
9. Demarche S, Schleich F, Henket M, et al. Detailed analysis of sputum and systemic inflammation in asthma phenotypes: are paucigranulocytic asthmatics really non-inflammatory? BMC Pulm Med, 2016, 16: 46.
10. Jang AS, Park JS, Lee JH, et al. The impact of smoking on clinical and therapeutic effects in asthmatics. J Korean Med Sci, 2009, 24(2): 209-214.
11. Wilson SJ, Ward JA, Sousa AR, et al. Severe asthma exists despite suppressed tissue inflammation: findings of the U-BIOPRED study. Eur Respir J, 2016, 48(5): 1307-1319.
12. St-Laurent J, Bergeron C, Pagé N, et al. Influence of smoking on airway inflammation and remodelling in asthma. Clin Exp Allergy, 2008, 38(10): 1582-1589.
13. Polosukhin VV, Richmond BW, Du RH, et al. Secretory IgA deficiency in individual small airways is associated with persistent inflammation and remodeling. Am J Respir Crit Care Med, 2017, 195(8): 1010-1021.
14. Richmond BW, Du RH, Han W, et al. Bacterial-derived neutrophilic inflammation drives lung remodeling in a mouse model of chronic obstructive pulmonary disease. Am J Respir Cell Mol Biol, 2018, 58(6): 736-744.
15. Lv MY, Qiang LX, Li ZH, et al. The lower the eosinophils, the stronger the inflammatory response? The relationship of different levels of eosinophils with the degree of inflammation in acute exacerbation chronic obstructive pulmonary disease (AECOPD). J Thorac Dis, 2021, 13(1): 232-243.
16. Hastie AT, Martinez FJ, Curtis JL, et al. Association of sputum and blood eosinophil concentrations with clinical measures of COPD severity: an analysis of the SPIROMICS cohort. Lancet Respir Med, 2017, 5(12): 956-967.
17. Weir M, Zhao H, Han MK, et al. Eosinophils in chronic obstructive pulmonary disease, the SPIROMICS cohort. American Journal of Respiratory and Critical Care Medicine, 2014, 189(A1): A5902.
18. Macdonald MI, Osadnik CR, Bulfin L, et al. MULTI-PHACET: multidimensional clinical phenotyping of hospitalised acute COPD exacerbations. ERJ Open Res, 2021, 7(3): 00198-2021.
19. Lu Y, Huang Y, Li J, et al. Eosinophil extracellular traps drive asthma progression through neuro-immune signals. Nat Cell Biol, 2021, 23(10): 1060-1072.
20. Bafadhel M, Davies L, Calverley PM, et al. Blood eosinophil guided prednisolone therapy for exacerbations of COPD: a further analysis. Eur Respir J, 2014, 44(3): 789-791.
21. Lipson DA, Barnhart F, Brealey N, et al. Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD. N Engl J Med, 2018, 378(18): 1671-1680.
22. Papi A, Vestbo J, Fabbri L, et al. Extrafine inhaled triple therapy versus dual bronchodilator therapy in chronic obstructive pulmonary disease (TRIBUTE): a double-blind, parallel group, randomised controlled trial. Lancet, 2018, 391(10125): 1076-1084.
23. Wedzicha JA, Calverley PM, Seemungal TA, et al. The prevention of chronic obstructive pulmonary disease exacerbations by salmeterol/fluticasone propionate or tiotropium bromide. Am J Respir Crit Care Med, 2008, 177(1): 19-26.
24. Vedel-Krogh S, Nielsen SF, Lange P, et al. Blood eosinophils and exacerbations in chronic obstructive pulmonary disease. The Copenhagen General Population Study. Am J Respir Crit Care Med, 2016, 193(9): 965-974.
25. Siddiqui SH, Guasconi A, Vestbo J, et al. Blood eosinophils: a biomarker of response to extrafine beclomethasone/formoterol in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2015, 192(4): 523-525.
26. 尹婧婧, 张巍, 张茗, 等. 外周血嗜酸粒细胞与老年慢性阻塞性肺疾病急性加重患者临床特征及短期预后的关系研究. 实用心脑肺血管病杂志, 2023, 31(5): 45-49.
27. Bafadhel M, Peterson S, De Blas MA, et al. Predictors of exacerbation risk and response to budesonide in patients with chronic obstructive pulmonary disease: a post-hoc analysis of three randomised trials. Lancet Respir Med, 2018, 6(2): 117-126.
28. Pascoe S, Locantore N, Dransfield MT, et al. 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. Lancet Respir Med, 2015, 3(6): 435-442.
29. Couillard S, Larivée P, Courteau J, et al. Eosinophils in COPD exacerbations are associated with increased readmissions. Chest, 2017, 151(2): 366-373.

Chinese Journal of Respiratory and Critical Care Medicine

Study on the correlation between EOS and clinical features and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content