Chronic obstructive pulmonary disease (COPD) is a disease of the lungs that makes it hard to breathe. COPD can lead chronic breathing problems and even death. One of the main causes of this disease is smoking cigarettes, but COPD can also be caused by other factors, such as dust. There is no cure for this disease, but symptoms (difficulty in breathing) can be managed with treatment. Medicines that are inhaled are often used to help improve breathing. But these are not effective in all patients, meaning some patients continue to have problems breathing even after using inhaled medicines. We would like to be able to determine which patient groups have improved breathing so that we only treat people who will benefit from the medicine. One factor that may be useful to identify these patients is a type of blood cell called an 'eosinophil'. The level of eosinophils can be identified following a blood test. People with high eosinophil levels in their blood are perceived to benefit (improved breathing) more from inhaled medicines. This study will aim to see if these eosinophil blood levels can help identify which people using inhaled medicines will have improvements in their breathing.
Chronic obstructive pulmonary disease (COPD) is a medical condition characterized by enhanced airway inflammation, and is known to be responsible for mortality and morbidity of millions of individuals worldwide. While traditionally lymphocytes, macrophages and neutrophils were considered key players in the inflammatory process of COPD, recent findings suggest that eosinophils have a key role in the disease pathophysiology. Exacerbations of COPD are the primary outcome as these greatly affect a patients' quality of life. The benefits of inhaled corticosteroids (ICS) to reduce exacerbations have mainly been observed in patients having eosinophil airways inflammation. Thus, the purpose of this study is to evaluate the association between the use of ICS among patients with or without blood eosinophilic inflammation, and the risk of exacerbations. This study will be a cohort study of all users of ICS. The primary outcome of the study will be a COPD exacerbation (secondary outcomes include: COPD-related hospitalizations or death). We will use Cox regression analysis to identify the risk of exacerbations, hospitalisation and all-cause mortality adjusting for relevant confounders, among patients with different blood eosinophil levels, and Kaplan Meier curves will be used to show the difference in survival time. Exposure to ICS will be determined time-dependently.
Acute exacerbations of COPD; COPD Hospitalisation; All-cause mortality.
Frank de Vries - Chief Investigator - Utrecht University
Frank de Vries - Corresponding Applicant - Utrecht University
Andrea Burden - Collaborator - ETH Zurich
Anke-Hilse Maitland-van der Zee - Collaborator - University of Amsterdam
Anthonius de Boer - Collaborator - Utrecht University
Dionne Braeken - Collaborator - Utrecht University
Frits Franssen - Collaborator - CIRO
Miel (Emiel) Wouters - Collaborator - CIRO
Olorunfemi Oshagbemi - Collaborator - Utrecht University