Monitoring COPD Patients According to the GOLD 2017 Document: Systemic and Bronchial Inflammation

Introduction: Exacerbation risk was associated with increased blood eosinophils in COPD patients. The aim of the study was to monitor COPD patients according to exacerbations and symptoms (GOLD 2017) while evaluating blood and sputum eosinophils. Methods: Mild-moderate COPD patients only treated with single or double bronchodilators were recruited. Blood and sputum eosinophils were evaluated every 6 months for 24 months. Results: In this ongoing study 62 patients were recruited; 31 reached T18 and 17 T24. At T0, 67.2% had blood eosinophils ≥2% and 32.3% sputum eosinophils ≥3%. Current smokers had blood leukocyte and eosinophil counts higher than ex-smokers, P=0.02. Patients with sputum eosinophils ≥3% had higher CAT (P=0.002). The follow-up analysis was limited to patients who reached T18; 64.5% maintained bronchodilator only, whereas in 19.3% ICS was added. Blood and sputum eosinophils did not significantly change during the follow-up. None of the inflammatory or functional variables at T0 predicted the addition of ICS during the follow-up. The few patients who experienced ≥1 exacerbations from T0 to T18 (n=8) showed no differences in inflammatory and clinical variables compared with those without exacerbations (n=23). Blood eosinophils at T0 correlated with those at T18 (rho=0.42; P=0.03 for %; rho=0.46, P=0.02 for count). Delta FEV1 (T18-T0) correlated with blood eosinophils (%) at T18 (rho=0.53, P=0.01). Conclusions: In mild-moderate COPD patients, discrepancy between blood and sputum eosinophils persisted over an 18-month period. A preliminary analysis showed that a few patients experienced exacerbations after 18 months and no inflammatory variables predicted these events.