GAO Fan , WANG Qingxiu , LI Rui , HAN Xiaopeng , LIU Yingli , LIU Jianbo
  • Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P. R. China;
LIU Jianbo, Email: jbliuzz@163.com
Acute exacerbation of chronic obstructive pulmonary disease; Inhaled glucocorticoid; Eosinophils
10.7507/1671-6205.202104022
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Objective  To study the effect of glucocorticoid-containing triple therapy on the acute exacerbation frequency of patients with moderate to severe chronic obstructive pulmonary disease (COPD) with different blood eosinophil percentage (EOS%). Methods  One hundred and twenty-four patients who were admitted to the hospital with moderate to severe COPD from January 2020 to March 2020 in the Department of Respiratory and Critical Care Medicine in this hospital were selected as the research subjects, and the patients were divided into group A according to EOS% (EOS%<2%) and B group (EOS%≥2%). Then the A and B groups were randomly divided into four subgroups A1, A2 and B1, B2, and the patients in groups A1 and B1 were treated with dual long-acting bronchodilation. The medication for the patients in groups A2 and B2 was a triple preparation containing glucocorticoids. Namely A1 group (EOS%<2%, dual therapy), A2 group (EOS%<2%, triple therapy), B1 group (EOS%≥2%, dual therapy), B2 group (EOS%≥2%, triple therapy). The patients were instructed to take medication regularly as in hospital after discharge. After discharge, patients were followed up by telephone every two weeks for a period of one year. The number of acute exacerbations, the change of forced expiratory volume in the first second as a percentage of the expected value (FEV1%pred) and the incidence of pneumonia were compared between group A and group B during the follow-up period of one year. Results  In the patients with EOS%≥2%, triple therapy reduced the number of acute attacks by 40% during treatment compared with dual therapy patients (average 0.875 vs. 1.471 times per patient per year, P=0.0278). While in the patients with EOS%<2%, it was reduced by 4% (1.080 vs. 1.125 times, P=0.3527). In the same use of glucocorticoid-containing triple preparations, the number of acute exacerbations in the patients with EOS%≥2% during medication was 19% less than that of the patients with EOS%<2% (an average of 0.875 to 1.080 times per patient per year, P=0.0462). Regardless of EOS%≥2% or <2%, there was no significant difference in the changes of FEV1%pred between triple therapy and double therapy patients before and after treatment (P>0.05). Regardless of EOS%≥2% or <2%, there was no statistically significant difference in the incidence of pneumonia between patients with triple therapy and double therapy during medication (P>0.05). Conclusion  Inhaled glucocorticoid triple therapy is suitable for moderate to severe COPD patients with high percentages of blood eosinophils.

Citation： GAO Fan, WANG Qingxiu, LI Rui, HAN Xiaopeng, LIU Yingli, LIU Jianbo. The effect of inhaled glucocorticoid triple therapy on the frequency of acute exacerbations in patients with moderate to severe chronic obstructive pulmonary disease with different blood eosinophil percentage. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(10): 685-689. doi: 10.7507/1671-6205.202104022 Copy

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