AI Article Synopsis

  • - Inhaled corticosteroid (ICS) medications are effective in slowing the decline of lung function (FEV) in COPD patients, and this effect is generally consistent, regardless of blood eosinophil (EOS) levels.
  • - A large study involving 26,675 COPD patients found that those on ICS experienced a slower decline in FEV compared to those not on ICS, with prevalent ICS users showing a -12.6 mL/year change versus -21.1 mL/year in non-users.
  • - While new users of ICS (incident ICS users) showed an improvement in FEV change, specifically in those with high EOS levels, the benefit tended to diminish over time, indicating that initial improvements may not be

Article Abstract

Inhaled corticosteroid (ICS)-containing medications slow rate of decline of FEV. Blood eosinophil (EOS) levels are associated with the degree of exacerbation reduction with ICS. We investigated whether FEV decline differs between patients with and without ICS, stratified by blood EOS level. The UK Clinical Practice Research Datalink (primary care records) and Hospital Episode Statistics (hospital records) were used to identify COPD patients aged 35 years or older, who were current or ex-smokers with ≥2 FEV measurements ≥6 months apart. Prevalent ICS use and the nearest EOS count to start of follow-up were identified. Patients were classified at baseline as higher stratum EOS (≥150 cell/µL) on ICS; higher stratum EOS not on ICS; lower stratum EOS (<150 cells/µL) on ICS; and lower stratum EOS not on ICS. In addition, an incident ICS cohort was used to investigate the rate of FEV change by EOS and incident ICS use. Mixed-effects linear regression was used to compare rates of FEV change in mL/year. A total of 26,675 COPD patients met our inclusion criteria (median age 69, 46% female). The median duration of follow up was 4.2 years. The rate of FEV change in prevalent ICS users was slower than non-ICS users (-12.6 mL/year vs -21.1 mL/year;  =0.001). The rate of FEV change was not significantly different when stratified by EOS level. The rate of FEV change in incident ICS users increased (+4.2 mL/year) vs -21.2 mL/year loss in non-ICS users; <0.001. In patients with high EOS, incident ICS patients showed an increase in FEV (+12 mL/year) compared to non-ICS users whose FEV decreased (-20.8 mL/year); <0.001. No statistical difference was seen in low EOS patients. Incident ICS use is associated with an improvement in FEV change, however, over time this association is lost. Regardless of blood EOS level, prevalent ICS use is associated with slower rates of FEV decline in COPD.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6536812PMC
http://dx.doi.org/10.2147/COPD.S200919DOI Listing

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