TY - JOUR

T1 - Time-Updated Phenotypic Guidance of Corticosteroids and Antibiotics in COPD

T2 - Rationale, Perspective and a Proposed Method

AU - Jordan, Alexander

AU - Sivapalan, Pradeesh

AU - Rømer, Valdemar

AU - Jensen, Jens Ulrik

N1 - Funding Information: This study was funded by The Novo Nordisk Foundation (grant number: NNF20OC0060657). The grant period started on September 1, 2020 and lasts for 5 years following that date. The grant must be utilized within this period. The administrating institution is Gentofte Hospital. Publisher Copyright: © 2023 by the authors.

PY - 2023/5

Y1 - 2023/5

N2 - Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with distinct phenotypes, each having distinct treatment needs. Eosinophilic airway inflammation is present in a subset of COPD patients in whom it can act as a driver of exacerbations. Blood eosinophil counts are a reliable way to identify patients with an eosinophilic phenotype, and these measurements have proven to be successful in guiding the use of corticosteroids in moderate and severe COPD exacerbations. Antibiotic use in COPD patients induces a risk of Clostridium difficile infection, diarrhea, and antibiotic resistance. Procalcitonin could possibly guide antibiotic treatment in patients admitted with AECOPD. Current studies in COPD patients were successful in reducing exposure to antibiotics with no changes in mortality or length of stay. Daily monitoring of blood eosinophils is a safe and effective way to reduce oral corticosteroid exposure and side effects for acute exacerbations. No evidence on time-updated treatment guidance for stable COPD exists yet, but a current trial is testing an eosinophil-guided approach on inhaled corticosteroid use. Procalcitonin-guided antibiotic treatment in AECOPD shows promising results in safely and substantially reducing antibiotic exposure both in time-independent and time-updated algorithms.

AB - Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with distinct phenotypes, each having distinct treatment needs. Eosinophilic airway inflammation is present in a subset of COPD patients in whom it can act as a driver of exacerbations. Blood eosinophil counts are a reliable way to identify patients with an eosinophilic phenotype, and these measurements have proven to be successful in guiding the use of corticosteroids in moderate and severe COPD exacerbations. Antibiotic use in COPD patients induces a risk of Clostridium difficile infection, diarrhea, and antibiotic resistance. Procalcitonin could possibly guide antibiotic treatment in patients admitted with AECOPD. Current studies in COPD patients were successful in reducing exposure to antibiotics with no changes in mortality or length of stay. Daily monitoring of blood eosinophils is a safe and effective way to reduce oral corticosteroid exposure and side effects for acute exacerbations. No evidence on time-updated treatment guidance for stable COPD exists yet, but a current trial is testing an eosinophil-guided approach on inhaled corticosteroid use. Procalcitonin-guided antibiotic treatment in AECOPD shows promising results in safely and substantially reducing antibiotic exposure both in time-independent and time-updated algorithms.

KW - acute exacerbation of COPD

KW - biomarkers

KW - COPD

KW - corticosteroids

KW - eosinophils

KW - inhaled corticosteroids

KW - procalcitonin

KW - respiratory tract infections

U2 - 10.3390/biomedicines11051395

DO - 10.3390/biomedicines11051395

M3 - Review

C2 - 37239067

AN - SCOPUS:85160721540

VL - 11

JO - Biomedicines

JF - Biomedicines

SN - 2227-9059

IS - 5

M1 - 1395

ER -