Incidence and profile of severe exacerbations of chronic obstructive pulmonary disease due to biomass smoke or tobacco

INTRODUCTION AND OBJECTIVES:

Stable chronic obstructive pulmonary disease (COPD) caused by biomass smoke (B-COPD) has some differences from tobacco-induced-COPD (T-COPD), but acute exacerbations (AECOPD) have not been well characterized in B-COPD.

OBJECTIVE:

To compare the incidence, characteristics and outcomes of AECOPD in B-COPD with those of T-COPD.

METHODS:

A retrospective observational study that included consecutive patients seen at a specialized COPD clinic (2008–2021). The incidence of severe AECOPD that required hospital admission was studied. For the first AECOPD, the following variables were recorded: fever, coexistence of pneumonia, purulent sputum, eosinophil count, neutrophil to lymphocyte ratio, hypercapnia, and respiratory acidosis. Outcome variables were intensive care unit (ICU) admission, length of hospital stay, and mortality within 1 month of hospital admission.

RESULTS:

Of 1060 subjects, 195 (18.4%) belonged to the B-COPD group and 865 (81.6%) to the T-COPD group. During a follow-up of 67.9 (37.8–98.8) months, 75 (38.4%) patients in the B-COPD group and 319 (36.8%) in the T-COPD group suffered at least one severe AECOPD. The only difference between groups was in a higher risk of ICU admission for the T-COPD group. The incidence, characteristics, and the rest of the outcomes of AECOPD were similar for both groups.

CONCLUSION:

AECOPD are similar events for B-COPD and T-COPD and should be managed similarly.

A new, three-dimensional approach to the GOLD COPD assessment tool

BACKGROUND

The 2-dimensional, 4-quadrant 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD A-D assessment tool (GOLD₂₀₁₇) does not include lung function variables to classify patients into different risk groups. The previous 2011 tool (GOLD₂₀₁₁) classified cases in the upper-quadrants (higher risk groups) regardless of whether they had a history of exacerbations or worse lung function. We hypothesized that a modified, three-dimensional classification (GOLD_3D) that separately includes assessment of lung function and exacerbations history would improve the ability to predict adverse events.

METHODS

A total of 1303 COPD patients were included in a historical cohort study. The ability of GOLD_3D to predict outcomes (all-cause death and hospitalizations due to severe exacerbation) was compared with GOLD₂₀₁₇ and GOLD₂₀₁₁.

RESULTS

Mean follow-up was 45.0 ± 28.0 months. Two hundred and twenty-eight patients (17.5%) died and 337 (25.9%) subjects suffered at least a severe exacerbation that required hospital admission. The area under the receiver-operating characteristics curve for mortality prediction was slightly but significantly higher for GOLD_3D than for GOLD₂₀₁₁. The area under the curve for prediction of severe exacerbations was significantly higher for GOLD_3D than for GOLD₂₀₁₁ and GOLD₂₀₁₇. A worse ventilatory obstruction was associated in most cases with a higher mortality risk and a higher exacerbation risk for the GOLD2017 A-D groups.

CONCLUSIONS

The proposed GOLD_3D classification system upgrades the previous ones, and is advantageous in predicting future adverse events.

Efficacy of mepolizumab in usual clinical practice and characteristics of responders

BACKGROUND

Severe eosinophilic asthma is a high-burden disease. Mepolizumab has been effective in several randomized clinical trials. However, such success might not be applicable to patients treated in usual clinical practice. The objectives of this article are to evaluate the efficacy of mepolizumab in severe uncontrolled eosinophilic asthma under usual clinical practice, and to determine characteristics associated with the response to this treatment.

METHODS

We have conducted a retrospective, multicentre study, including all adult patients with severe uncontrolled eosinophilic asthma in Galicia, Spain, on whom mepolizumab treatment was started before June 2020, at least 6 months before the time of inclusion, and had received at least one dose of the drug. Patient characteristics, clinical data, respiratory function and comorbidities were collected at baseline and at the 6-month-follow-up. Responders and super-responders were defined according to clinical response and requirement of systemic corticosteroids.

RESULTS

122 patients (mean age 58 years old) were included. In the follow-up treatment 6 months later, 75.4% of the patients were well-controlled, displaying a significant reduction in blood eosinophil counts (p < 0.001), hospital admissions and disease exacerbations (p < 0.001), and had their systemic glucocorticosteroid dose significantly reduced (p < 0.001). The inhaled corticosteroid dose was also lowered (p < 0.01) after 6 months of treatment. Around two-thirds had a clinically significant increase in FEV1, 95% of the patients were considered responders and 43% super-responders.

CONCLUSION

In routine clinical practice, mepolizumab is effective in patients with severe eosinophilic asthma and it has a good safety profile.