The Experts below are selected from a list of 23523 Experts worldwide ranked by ideXlab platform
Copdgene Investigators - One of the best experts on this subject based on the ideXlab platform.
-
blood Eosinophil Count thresholds and exacerbations in patients with chronic obstructive pulmonary disease
The Journal of Allergy and Clinical Immunology, 2018Co-Authors: Copdgene InvestigatorsAbstract:Background Eosinophilic airway inflammation in patients with chronic obstructive pulmonary disease (COPD) is associated with exacerbations and responsivity to steroids, suggesting potential shared mechanisms with Eosinophilic asthma. However, there is no consistent blood Eosinophil Count that has been used to define the increased exacerbation risk. Objective We sought to investigate blood Eosinophil Counts associated with exacerbation risk in patients with COPD. Methods Blood Eosinophil Counts and exacerbation risk were analyzed in patients with moderate-to-severe COPD by using 2 independent studies of former and current smokers with longitudinal data. The Genetic Epidemiology of COPD (COPDGene) study was analyzed for discovery (n = 1,553), and the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study was analyzed for validation (n = 1,895). A subset of the ECLIPSE study subjects were used to assess the stability of blood Eosinophil Counts over time. Results COPD exacerbation risk increased with higher Eosinophil Counts. An Eosinophil Count threshold of 300 cells/μL or greater showed adjusted incidence rate ratios for exacerbations of 1.32 in the COPDGene study (95% CI, 1.10-1.63). The cutoff of 300 cells/μL or greater was validated for prospective risk of exacerbation in the ECLIPSE study, with adjusted incidence rate ratios of 1.22 (95% CI, 1.06-1.41) using 3-year follow-up data. Stratified analysis confirmed that the increased exacerbation risk associated with an Eosinophil Count of 300 cells/μL or greater was driven by subjects with a history of frequent exacerbations in both the COPDGene and ECLIPSE studies. Conclusions Patients with moderate-to-severe COPD and blood Eosinophil Counts of 300 cells/μL or greater had an increased risk exacerbations in the COPDGene study, which was prospectively validated in the ECLIPSE study.
Trung N Tran - One of the best experts on this subject based on the ideXlab platform.
-
association between blood Eosinophil Count and risk of readmission for patients with asthma historical cohort study
PLOS ONE, 2018Co-Authors: Marjan Kerkhof, Trung N Tran, Maarten Van Den Berge, Guy G Brusselle, Gokul Gopalan, Rupert Jones, Janwillem W H Kocks, Andrew Menziesgow, Javier Nuevo, Ian D PavordAbstract:Background Recent studies have demonstrated an association between high blood Eosinophil Counts and greater risk of asthma exacerbations. We sought to determine whether patients hospitalized for an asthma exacerbation were at greater risk of readmission if they had a high blood Eosinophil Count documented before the first hospitalization. Methods This historical cohort study drew on 2 years of medical record data (Clinical Practice Research Datalink with Hospital Episode Statistics linkage) of patients (aged ≥5 years) admitted to hospital in England for asthma, with recorded blood Eosinophil Count within 1 baseline year before admission. We analyzed the association between high blood Eosinophil Count (≥0.35x109 cells/L) and readmission risk during 1 year of follow-up after hospital discharge, with adjustment for predefined, relevant confounders using forward selection. Results We identified 2,613 eligible patients with asthma-related admission, of median age 51 years (interquartile range, 36–69) and 76% women (1,997/2,613). Overall, 835/2,613 (32.0%) had a preadmission high blood Eosinophil Count. During the follow-up year, 130/2,613 patients (5.0%) were readmitted for asthma, including 55/835 (6.6%) with vs. 75/1,778 (4.2%) without high blood Eosinophil Count at baseline (adjusted hazard ratio [HR] 1.49; 95% CI 1.04–2.13, p = 0.029). The association was strongest in never-smokers (n = 1,296; HR 2.16, 95% CI 1.27–3.68, p = 0.005) and absent in current smokers (n = 547; HR 1.00, 95% CI 0.49–2.04, p = 0.997). Conclusions A high blood Eosinophil Count in the year before an asthma-related hospitalization is associated with increased risk of readmission within the following year. These findings suggest that patients with asthma and preadmission high blood Eosinophil Count require careful follow-up, with treatment optimization, after discharge.
-
Relationship of Blood Eosinophil Count to Exacerbations in Chronic Obstructive Pulmonary Disease
The journal of allergy and clinical immunology. In practice, 2017Co-Authors: Robert S. Zeiger, Trung N Tran, Michael Schatz, Deepak B. Khatry, Rebecca K. Butler, Ubaldo Martin, Aniket A. Kawatkar, Wansu ChenAbstract:Background Eosinophilic airway inflammation characterizes a chronic obstructive pulmonary disease (COPD) phenotype that requires more study. Objective To investigate the relationship of blood Eosinophil Count to exacerbations in COPD. Methods Using administrative pharmacy and health care utilization data from 2009 to 2012, we retrospectively identified patients 40 years or older with a COPD diagnosis, postbronchodilator FEV1/forced vital capacity ratio of less than 0.7, and a blood Eosinophil Count (N = 7,245). COPD exacerbations were defined as hospitalizations or emergency department visits with a primary diagnosis of COPD, or outpatient visits with systemic corticosteroid dispensing within ±14 days associated with an enCounter code consistent with a COPD exacerbation. The relationship between the index blood Eosinophil Count and the rate of COPD exacerbations in the follow-up year was determined by multivariable analyses. Results Patients with COPD were predominantly male (57.1%), white (71.8%), often current or past smokers (75.4%), and had frequent comorbidities; 19.0% had Eosinophil Counts of greater than or equal to 300 cells/mm3, 76.1% were classified as moderate to very severe by lung function, and the COPD exacerbation rate was 0.38 per year (95% CI, 0.37-0.40). After adjustment for potential confounders, COPD exacerbations during 1-year follow-up were significantly greater for patients with blood Eosinophil Counts of greater than or equal to 300 cells/mm3 (rate ratio [RR], 1.25; 95% CI, 1.10-1.43), greater than or equal to 400 cells/mm3 (RR, 1.48; 95% CI, 1.26-1.75), and greater than or equal to 500 cells/mm3 (RR, 1.76; 95% CI, 1.45-2.14), respectively, compared with patients with Eosinophils lower than the cutoffs. Conclusions In this study, high blood Eosinophil Counts were an independent risk factor for future exacerbations in patients with COPD, a phenotype that might benefit from therapy directed at Eosinophilic-driven disease and inflammation.
-
Relationship of blood Eosinophil Count to exacerbations in asthma patients with a COPD diagnosis
6.1 Epidemiology, 2015Co-Authors: Trung N Tran, Michael Schatz, Wansu Chen, Deepak B. Khatry, Robert S. ZeigerAbstract:Rationale: Elevated blood Eosinophil Count is a risk factor for future exacerbations in persistent adult asthma. We investigated whether a relationship also exists in asthma patients with a COPD diagnosis (AS-COPD). Methods: From pharmacy and healthcare utilization data in a Managed Care Organization, we identified 901 patients aged 18-64 years who met the HEDIS 2-year criteria for persistent asthma in 2009-2010, had ICD-9 diagnoses of COPD or chronic obstructive asthma (COA) during 2004-2010, and a blood Eosinophil Count in 2010. We examined the relationship between blood Eosinophil Count (2010) and asthma exacerbation rate in 2011 adjusting for demographics, disease burden, and comorbidities. Results: 65% of the AS-COPD cohort had at least one COPD, 69% one COA (2004-2010) and 79% one non-COA asthma diagnosis (2009-2010). A blood Eosinophil cutoff point ≥400/mm 3 (2010) related best to future asthma exacerbations (adjusted RR=1.44, 95% CI 1.09, 1.90). Other factors in 2010 that remained statistically significant in the multivariable models were COA diagnosis, history of asthma exacerbations, ≥7 short-acting beta-agonist canisters dispensed, female gender, and obesity. Conclusions: Elevated blood Eosinophil Count was a risk factor for future asthma exacerbations in AS-COPD as reported in persistent asthma with no COPD/COA diagnoses, suggesting a common inflammatory mechanism in both phenotypes.
-
high blood Eosinophil Count is a risk factor for future asthma exacerbations in adult persistent asthma
The Journal of Allergy and Clinical Immunology: In Practice, 2014Co-Authors: Robert S. Zeiger, Michael Schatz, Wansu Chen, Deepak B. Khatry, David Gossage, Trung N TranAbstract:Background Exacerbation-associated uncontrolled asthma represents a major public health problem. The relationship of elevated blood Eosinophils to this process needs study. Objective To determine whether a high blood Eosinophil Count is a risk factor for future asthma exacerbations in adult persistent asthma. Methods By using electronic pharmacy and health care data from Kaiser Permanente Southern California, 2392 patients, ages 18 to 64 years, were identified who met the Health Effectiveness Data and Information Set 2-year criteria for persistent asthma, did not manifest chronic obstructive pulmonary disease and other major illnesses, and had a blood Eosinophil determination in 2010. Exacerbations (primary outcome) were defined as asthma outpatient visits that required systemic corticosteroid dispensing within ±7 days or asthma emergency department visits or hospitalizations. A period of ≥8 days defined a new exacerbation. Multivariate modelling used negative binomial and Poisson regression to examine the association between a blood Eosinophil Count determined in 2010 and risk of exacerbations, and ≥7 short-acting β2-agonist (SABA) canisters dispensed (secondary outcome) in 2011 by adjusting for demographics, comorbidities, and asthma burden. Results The rate of asthma exacerbations in 2011 was 0.41 events per person year (95% CI, 0.37-0.45). Eosinophil Count ≥400/mm3 in 2010 was a risk factor for asthma exacerbations in 2011 (adjusted rate ratio 1.31 [95% CI, 1.07-1.60]; P = .009) and ≥7 SABA dispensed (adjusted risk ratio 1.17 [95% CI, 1.03-1.1.33]; P = .015). Conclusion A high blood Eosinophil Count is a risk factor for increased future asthma exacerbations and excessive short-acting β2-agonist use after adjustment of potential confounders in adults with persistent asthma, which suggests a higher disease burden in patients with asthma and with high blood Eosinophil Counts.
-
High blood Eosinophil Count is associated with more frequent asthma attacks in asthma patients.
Annals of allergy asthma & immunology : official publication of the American College of Allergy Asthma & Immunology, 2014Co-Authors: Trung N Tran, Deepak B. Khatry, Christine Ward, David GossageAbstract:Abstract Background The clinical importance of Eosinophils in asthma has been shown by the observation of frequent exacerbation in patients with high sputum Eosinophil Counts and a corresponding decrease in exacerbations when anti-inflammatory therapy was adjusted to maintain low sputum Eosinophil percentages. However, less is known of the relation between blood Eosinophilia and asthma exacerbation. Objective To examine whether patients with asthma and a higher blood Eosinophil Count have more asthma attacks than those with a lower Count. Methods The authors analyzed data from the National Health and Nutrition Examination Survey, an annual cross-sectional survey of the US general population. Patients with asthma and asthma attacks were identified based on participants' self-report or parental report. A high blood Eosinophil Count was defined using 200, 300, or 400 cells/μL as cutoffs. The primary analysis used data from 2001 through 2010 after adjusting for demographic variables, obesity, smoking, neutrophil level, and past treatment for wheezing. A secondary analysis used data from 2007 through 2010 and included recent treatment for asthma and fraction of exhaled nitric oxide level as additional adjustment variables. Results In survey years 2001 through 2010, 3,162 patients with asthma had blood Eosinophil data and approximately half (54% of children and 52% of adults) reported an asthma attack in the previous year. In the primary analysis, higher blood Eosinophil Counts were associated with more asthma attacks in children but not in adults. The secondary analysis suggested an association in both children and adults. Conclusion Patients with asthma with higher blood Eosinophil Counts experienced more asthma attacks than those with lower Eosinophil Counts.
Robert S. Zeiger - One of the best experts on this subject based on the ideXlab platform.
-
Relationship of Blood Eosinophil Count to Exacerbations in Chronic Obstructive Pulmonary Disease
The journal of allergy and clinical immunology. In practice, 2017Co-Authors: Robert S. Zeiger, Trung N Tran, Michael Schatz, Deepak B. Khatry, Rebecca K. Butler, Ubaldo Martin, Aniket A. Kawatkar, Wansu ChenAbstract:Background Eosinophilic airway inflammation characterizes a chronic obstructive pulmonary disease (COPD) phenotype that requires more study. Objective To investigate the relationship of blood Eosinophil Count to exacerbations in COPD. Methods Using administrative pharmacy and health care utilization data from 2009 to 2012, we retrospectively identified patients 40 years or older with a COPD diagnosis, postbronchodilator FEV1/forced vital capacity ratio of less than 0.7, and a blood Eosinophil Count (N = 7,245). COPD exacerbations were defined as hospitalizations or emergency department visits with a primary diagnosis of COPD, or outpatient visits with systemic corticosteroid dispensing within ±14 days associated with an enCounter code consistent with a COPD exacerbation. The relationship between the index blood Eosinophil Count and the rate of COPD exacerbations in the follow-up year was determined by multivariable analyses. Results Patients with COPD were predominantly male (57.1%), white (71.8%), often current or past smokers (75.4%), and had frequent comorbidities; 19.0% had Eosinophil Counts of greater than or equal to 300 cells/mm3, 76.1% were classified as moderate to very severe by lung function, and the COPD exacerbation rate was 0.38 per year (95% CI, 0.37-0.40). After adjustment for potential confounders, COPD exacerbations during 1-year follow-up were significantly greater for patients with blood Eosinophil Counts of greater than or equal to 300 cells/mm3 (rate ratio [RR], 1.25; 95% CI, 1.10-1.43), greater than or equal to 400 cells/mm3 (RR, 1.48; 95% CI, 1.26-1.75), and greater than or equal to 500 cells/mm3 (RR, 1.76; 95% CI, 1.45-2.14), respectively, compared with patients with Eosinophils lower than the cutoffs. Conclusions In this study, high blood Eosinophil Counts were an independent risk factor for future exacerbations in patients with COPD, a phenotype that might benefit from therapy directed at Eosinophilic-driven disease and inflammation.
-
blood Eosinophil Count and outcomes in severe uncontrolled asthma a prospective study
The Journal of Allergy and Clinical Immunology: In Practice, 2017Co-Authors: Robert S. Zeiger, Michael Schatz, Wansu Chen, Aniket A. Kawatkar, Anand A Dalal, Ekaterina Sadikova, Robert Suruki, Lei QianAbstract:Background Severe uncontrolled asthma (SUA) is associated with increased asthma exacerbations. Whether high blood Eosinophil Counts are related to this burden is uncertain. Objectives To determine the relationship of blood Eosinophil Counts to asthma exacerbations, utilization, and cost in patients with SUA. Methods Patients with persistent asthma (age ≥ 12 years) were identified administratively with SUA in phase I by evidencing (1) 2 or more asthma exacerbations; (2) 6 or more medium- or high-dose dispensed canisters of inhaled corticosteroid (ICS) as monotherapy or with long-acting β 2 -agonist; and (3) 3 or more dispensed non-ICS controllers. Of the 541 patients with SUA invited to participate in the prospective phase II follow-up study, 261 (48.2%) had blood tests (index date) to determine Eosinophil Count and other atopic biomarkers. The relationship of blood Eosinophil cutoff points to asthma exacerbations and direct costs 1 year after the index date were determined by multivariable regression. Results A blood Eosinophil cutoff point of greater than or equal to 400 cells/mm 3 compared with less than 400 cells/mm 3 , but not 150 cells/mm 3 or 300 cells/mm 3 , was a risk factor in the outcome year in adjusted analyses for 2 or more asthma exacerbations (risk ratio, 1.55; 95% CI, 1.02-2.35; P =.04) and any asthma emergency department visit or hospitalization (risk ratio, 2.29; 95% CI, 1.16-4.55; P =.02), but not for rate of asthma exacerbations or incremental total direct asthma costs per patient ($202; 95% CI, −286 to 691). Conclusions A high blood Eosinophil Count was an independent risk factor for 2 or more asthma exacerbations or any asthma emergency department visit or hospitalization, but not direct costs in patients with SUA, possibly constrained by limited power.
-
Relationship of blood Eosinophil Count to exacerbations in asthma patients with a COPD diagnosis
6.1 Epidemiology, 2015Co-Authors: Trung N Tran, Michael Schatz, Wansu Chen, Deepak B. Khatry, Robert S. ZeigerAbstract:Rationale: Elevated blood Eosinophil Count is a risk factor for future exacerbations in persistent adult asthma. We investigated whether a relationship also exists in asthma patients with a COPD diagnosis (AS-COPD). Methods: From pharmacy and healthcare utilization data in a Managed Care Organization, we identified 901 patients aged 18-64 years who met the HEDIS 2-year criteria for persistent asthma in 2009-2010, had ICD-9 diagnoses of COPD or chronic obstructive asthma (COA) during 2004-2010, and a blood Eosinophil Count in 2010. We examined the relationship between blood Eosinophil Count (2010) and asthma exacerbation rate in 2011 adjusting for demographics, disease burden, and comorbidities. Results: 65% of the AS-COPD cohort had at least one COPD, 69% one COA (2004-2010) and 79% one non-COA asthma diagnosis (2009-2010). A blood Eosinophil cutoff point ≥400/mm 3 (2010) related best to future asthma exacerbations (adjusted RR=1.44, 95% CI 1.09, 1.90). Other factors in 2010 that remained statistically significant in the multivariable models were COA diagnosis, history of asthma exacerbations, ≥7 short-acting beta-agonist canisters dispensed, female gender, and obesity. Conclusions: Elevated blood Eosinophil Count was a risk factor for future asthma exacerbations in AS-COPD as reported in persistent asthma with no COPD/COA diagnoses, suggesting a common inflammatory mechanism in both phenotypes.
-
high blood Eosinophil Count is a risk factor for future asthma exacerbations in adult persistent asthma
The Journal of Allergy and Clinical Immunology: In Practice, 2014Co-Authors: Robert S. Zeiger, Michael Schatz, Wansu Chen, Deepak B. Khatry, David Gossage, Trung N TranAbstract:Background Exacerbation-associated uncontrolled asthma represents a major public health problem. The relationship of elevated blood Eosinophils to this process needs study. Objective To determine whether a high blood Eosinophil Count is a risk factor for future asthma exacerbations in adult persistent asthma. Methods By using electronic pharmacy and health care data from Kaiser Permanente Southern California, 2392 patients, ages 18 to 64 years, were identified who met the Health Effectiveness Data and Information Set 2-year criteria for persistent asthma, did not manifest chronic obstructive pulmonary disease and other major illnesses, and had a blood Eosinophil determination in 2010. Exacerbations (primary outcome) were defined as asthma outpatient visits that required systemic corticosteroid dispensing within ±7 days or asthma emergency department visits or hospitalizations. A period of ≥8 days defined a new exacerbation. Multivariate modelling used negative binomial and Poisson regression to examine the association between a blood Eosinophil Count determined in 2010 and risk of exacerbations, and ≥7 short-acting β2-agonist (SABA) canisters dispensed (secondary outcome) in 2011 by adjusting for demographics, comorbidities, and asthma burden. Results The rate of asthma exacerbations in 2011 was 0.41 events per person year (95% CI, 0.37-0.45). Eosinophil Count ≥400/mm3 in 2010 was a risk factor for asthma exacerbations in 2011 (adjusted rate ratio 1.31 [95% CI, 1.07-1.60]; P = .009) and ≥7 SABA dispensed (adjusted risk ratio 1.17 [95% CI, 1.03-1.1.33]; P = .015). Conclusion A high blood Eosinophil Count is a risk factor for increased future asthma exacerbations and excessive short-acting β2-agonist use after adjustment of potential confounders in adults with persistent asthma, which suggests a higher disease burden in patients with asthma and with high blood Eosinophil Counts.
Hernando Knobel - One of the best experts on this subject based on the ideXlab platform.
-
Eosinophil Count and neutrophil-lymphocyte Count ratio as prognostic markers in patients with bacteremia: a retrospective cohort study.
PloS one, 2012Co-Authors: Roser Terradas, Santiago Grau, Jordi Blanch, Marta Riu, Pere Saballs, Xavier Castells, Juan Pablo Horcajada, Hernando KnobelAbstract:Introduction There is scarce evidence on the use of Eosinophil Count as a marker of outcome in patients with infection. The aim of this study was to evaluate whether changes in Eosinophil Count, as well as the neutrophil-lymphocyte Count ratio (NLCR), could be used as clinical markers of outcome in patients with bacteremia. Methods We performed a retrospective study of patients with a first episode of community-acquired or healthcare-related bacteremia during hospital admission between 2004 and 2009. A total of 2,311 patients were included. Cox regression was used to analyze the behaviour of Eosinophil Count and the NLCR in survivors and non-survivors. Results In the adjusted analysis, the main independent risk factor for mortality was persistence of an Eosinophil Count below 0.0454·103/uL (HR = 4.20; 95% CI 2.66–6.62). An NLCR value >7 was also an independent risk factor but was of lesser importance. The mean Eosinophil Count in survivors showed a tendency to increase rapidly and to achieve normal values between the second and third day. In these patients, the NLCR was 7 were independent markers of mortality in patients with bacteremia.
-
Eosinophil Count and neutrophil lymphocyte Count ratio as prognostic markers in patients with bacteremia a retrospective cohort study
PLOS ONE, 2012Co-Authors: Roser Terradas, Santiago Grau, Jordi Blanch, Marta Riu, Pere Saballs, Xavier Castells, Juan Pablo Horcajada, Hernando KnobelAbstract:Introduction There is scarce evidence on the use of Eosinophil Count as a marker of outcome in patients with infection. The aim of this study was to evaluate whether changes in Eosinophil Count, as well as the neutrophil-lymphocyte Count ratio (NLCR), could be used as clinical markers of outcome in patients with bacteremia. Methods We performed a retrospective study of patients with a first episode of community-acquired or healthcare-related bacteremia during hospital admission between 2004 and 2009. A total of 2,311 patients were included. Cox regression was used to analyze the behaviour of Eosinophil Count and the NLCR in survivors and non-survivors. Results In the adjusted analysis, the main independent risk factor for mortality was persistence of an Eosinophil Count below 0.0454·103/uL (HR = 4.20; 95% CI 2.66–6.62). An NLCR value >7 was also an independent risk factor but was of lesser importance. The mean Eosinophil Count in survivors showed a tendency to increase rapidly and to achieve normal values between the second and third day. In these patients, the NLCR was <7 between the second and third day. Conclusion Both sustained eosinopenia and persistence of an NLCR >7 were independent markers of mortality in patients with bacteremia.
Gokul Gopalan - One of the best experts on this subject based on the ideXlab platform.
-
association between blood Eosinophil Count and risk of readmission for patients with asthma historical cohort study
PLOS ONE, 2018Co-Authors: Marjan Kerkhof, Trung N Tran, Maarten Van Den Berge, Guy G Brusselle, Gokul Gopalan, Rupert Jones, Janwillem W H Kocks, Andrew Menziesgow, Javier Nuevo, Ian D PavordAbstract:Background Recent studies have demonstrated an association between high blood Eosinophil Counts and greater risk of asthma exacerbations. We sought to determine whether patients hospitalized for an asthma exacerbation were at greater risk of readmission if they had a high blood Eosinophil Count documented before the first hospitalization. Methods This historical cohort study drew on 2 years of medical record data (Clinical Practice Research Datalink with Hospital Episode Statistics linkage) of patients (aged ≥5 years) admitted to hospital in England for asthma, with recorded blood Eosinophil Count within 1 baseline year before admission. We analyzed the association between high blood Eosinophil Count (≥0.35x109 cells/L) and readmission risk during 1 year of follow-up after hospital discharge, with adjustment for predefined, relevant confounders using forward selection. Results We identified 2,613 eligible patients with asthma-related admission, of median age 51 years (interquartile range, 36–69) and 76% women (1,997/2,613). Overall, 835/2,613 (32.0%) had a preadmission high blood Eosinophil Count. During the follow-up year, 130/2,613 patients (5.0%) were readmitted for asthma, including 55/835 (6.6%) with vs. 75/1,778 (4.2%) without high blood Eosinophil Count at baseline (adjusted hazard ratio [HR] 1.49; 95% CI 1.04–2.13, p = 0.029). The association was strongest in never-smokers (n = 1,296; HR 2.16, 95% CI 1.27–3.68, p = 0.005) and absent in current smokers (n = 547; HR 1.00, 95% CI 0.49–2.04, p = 0.997). Conclusions A high blood Eosinophil Count in the year before an asthma-related hospitalization is associated with increased risk of readmission within the following year. These findings suggest that patients with asthma and preadmission high blood Eosinophil Count require careful follow-up, with treatment optimization, after discharge.
-
blood Eosinophil Count and prospective annual asthma disease burden a uk cohort study
The Lancet Respiratory Medicine, 2015Co-Authors: D Price, Anna Rigazio, Jonathan D Campbell, Eugene R Bleecker, C J Corrigan, Mike Thomas, Sally E Wenzel, Andrew M Wilson, Mary Buatti Small, Gokul GopalanAbstract:Summary Background Elevated sputum Eosinophil Counts predict asthma exacerbations and responsiveness to inhaled corticosteroids but are impractical to measure in primary care. We investigated the relation between blood Eosinophil Count and prospective annual asthma outcomes for a large UK cohort. Methods This historical cohort study used anonymised medical record data to identify primary care patients with asthma aged 12–80 years with 2 years of continuous records, including 1 year before (baseline) and 1 year after (outcome) their most recent Eosinophil Count. Negative binomial regression was used to compare outcome exacerbation rates and logistic regression to compare odds of asthma control for patients with blood Eosinophil Counts of 400 cells per μL or less versus greater than 400 cells per μL, adjusting for age, sex, body-mass index, smoking status, and Charlson comorbidity index. The study is registered at ClinicalTrials.gov, number NCT02140541. Findings Overall, 20 929 (16%) of 130 248 patients had blood Eosinophil Counts greater than 400 cells per μL. During the outcome year, these patients experienced significantly more severe exacerbations (adjusted rate ratio [RR] 1·42, 95% CI 1·36–1·47) and acute respiratory events (RR 1·28, 1·24–1·33) than those with Counts of 400 cells per μL or less. They also had significantly lower odds of achieving overall asthma control (OR 0·74, 95% CI 0·72–0·77), defined as limited reliever use and no asthma-related hospital attendance or admission, acute course of oral corticosteroids, or prescription for antibiotics. Exacerbation rates increased progressively with nine ascending categories of blood Eosinophil Count as compared with a reference category of 200 cells per μL or less. Interpretation Patients with asthma and blood Eosinophil Counts greater than 400 cells per μL experience more severe exacerbations and have poorer asthma control. Furthermore, a Count–response relation exists between blood Eosinophil Counts and asthma-related outcomes. Blood Eosinophil Counts could add predictive value to Global Initiative for Asthma control-based risk assessment. Funding Teva Pharmaceuticals.