ICS Use May Modify FEV1 Decline in α1-Antitrypsin Deficiency Patients with Relatively High Blood Eosinophils

Background: α 1 -Antitrypsin deficiency (AATD) predisposes to chronic obstructive pulmonary disease (COPD). In COPD unrelated to AATD, the role of a higher blood eosinophil count in disease and subsequent personalization of therapy has recently received much attention. We sought to investigate this...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Respiration 2018, Vol.95 (2), p.114-121
Hauptverfasser: Low, Emma V., Hughes, Siân M., Zaffarullah, Safia, Kantas, Dimitris, Stockley, Robert Andrew, Turner, Alice M.
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 121
container_issue 2
container_start_page 114
container_title Respiration
container_volume 95
creator Low, Emma V.
Hughes, Siân M.
Zaffarullah, Safia
Kantas, Dimitris
Stockley, Robert Andrew
Turner, Alice M.
description Background: α 1 -Antitrypsin deficiency (AATD) predisposes to chronic obstructive pulmonary disease (COPD). In COPD unrelated to AATD, the role of a higher blood eosinophil count in disease and subsequent personalization of therapy has recently received much attention. We sought to investigate this concept in patients with AATD-associated COPD. Objectives: The study aims to evaluate eosinophilia status against outcomes including mortality and FEV 1 decline in patients with AATD. Methods: All patients with PiSZ and PiZZ genotypes were identified from the UK AATD registry. The participants were substratified according to inhaled corticosteroid (ICS) use. Blood eosinophil counts were assessed from baseline and annually during follow-up (range 1–18 years). Eosinophilia was defined as a level >0.2 × 10 9 /L, and classified by the frequency of such counts into “always,” “intermittent,” or “never present.” Univariate and multivariate analyses were conducted. Results: In total, 646 participants were included, 53.9% of whom demonstrated intermittent and 7.4% persistent eosinophilia. Survival did not differ according to eosinophilic group (p > 0.05). Those with persistent eosinophilia showed a slower FEV 1 decline (p < 0.001). There was no clear association with exacerbation frequency. Patients on ICS at baseline were more likely to be eosinophilic (p = 0.002) and having a lower FEV 1 (p < 0.001) and greater pack-year exposure (16.5 vs. 7.8 pack-years, p < 0.001). When the multivariate analyses of FEV 1 decline were stratified for baseline ICS use, the association of persistent eosinophilia with slower decline persisted in those on ICS. Conclusions: Blood eosinophil levels persistently >0.2 × 10 9 /L may be an indication for ICS use in PiZZ AATD in order to reduce FEV 1 decline.
doi_str_mv 10.1159/000481867
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1159_000481867</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1978720042</sourcerecordid><originalsourceid>FETCH-LOGICAL-c1513-a42a06b8b9ea7851ddae3ef4821ca3f2e858d6401a563789d6c4e788a50291d93</originalsourceid><addsrcrecordid>eNo9kMtOwzAQRS0EoqWwYI-Ql7AIeOw4cZalD1qpFQgo28hNJq0hL-IUlM_iR_gmglq6mrnSuXdxCDkHdgMgg1vGmKtAef4B6YLLhcOE9A5JlzEuHT8Q0CEn1r4xBlIpfkw6POBSKFd0STYdPNOFRTrXDZ0XsUkaOh69Ah1ilJocqcnpzzc4_bw2ddWUts1DTExkMI8a-qjr9qkt_TL1mj5h2uZPTBs6Mas1vUuLIqajoi0V5dqk9pQcJTq1eLa7PbIYj14GE2f2cD8d9GdOBBKEo12umbdUywC1ryTEsUaBias4RFokHJVUsecy0NITvgpiL3LRV0pLxgOIA9EjV9vdsio-NmjrMDM2wjTVORYbG0LgK5-31niLXm_RqCqsrTAJy8pkumpCYOGf3XBvt2Uvd7ObZYbxnvzX2QIXW-BdVyus9sCu_wvU2nzL</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1978720042</pqid></control><display><type>article</type><title>ICS Use May Modify FEV1 Decline in α1-Antitrypsin Deficiency Patients with Relatively High Blood Eosinophils</title><source>MEDLINE</source><source>Karger Journals Complete</source><creator>Low, Emma V. ; Hughes, Siân M. ; Zaffarullah, Safia ; Kantas, Dimitris ; Stockley, Robert Andrew ; Turner, Alice M.</creator><creatorcontrib>Low, Emma V. ; Hughes, Siân M. ; Zaffarullah, Safia ; Kantas, Dimitris ; Stockley, Robert Andrew ; Turner, Alice M.</creatorcontrib><description>Background: α 1 -Antitrypsin deficiency (AATD) predisposes to chronic obstructive pulmonary disease (COPD). In COPD unrelated to AATD, the role of a higher blood eosinophil count in disease and subsequent personalization of therapy has recently received much attention. We sought to investigate this concept in patients with AATD-associated COPD. Objectives: The study aims to evaluate eosinophilia status against outcomes including mortality and FEV 1 decline in patients with AATD. Methods: All patients with PiSZ and PiZZ genotypes were identified from the UK AATD registry. The participants were substratified according to inhaled corticosteroid (ICS) use. Blood eosinophil counts were assessed from baseline and annually during follow-up (range 1–18 years). Eosinophilia was defined as a level &gt;0.2 × 10 9 /L, and classified by the frequency of such counts into “always,” “intermittent,” or “never present.” Univariate and multivariate analyses were conducted. Results: In total, 646 participants were included, 53.9% of whom demonstrated intermittent and 7.4% persistent eosinophilia. Survival did not differ according to eosinophilic group (p &gt; 0.05). Those with persistent eosinophilia showed a slower FEV 1 decline (p &lt; 0.001). There was no clear association with exacerbation frequency. Patients on ICS at baseline were more likely to be eosinophilic (p = 0.002) and having a lower FEV 1 (p &lt; 0.001) and greater pack-year exposure (16.5 vs. 7.8 pack-years, p &lt; 0.001). When the multivariate analyses of FEV 1 decline were stratified for baseline ICS use, the association of persistent eosinophilia with slower decline persisted in those on ICS. Conclusions: Blood eosinophil levels persistently &gt;0.2 × 10 9 /L may be an indication for ICS use in PiZZ AATD in order to reduce FEV 1 decline.</description><identifier>ISSN: 0025-7931</identifier><identifier>EISSN: 1423-0356</identifier><identifier>DOI: 10.1159/000481867</identifier><identifier>PMID: 29253843</identifier><language>eng</language><publisher>Basel, Switzerland</publisher><subject>Administration, Inhalation ; Adrenal Cortex Hormones - administration &amp; dosage ; Adult ; Aged ; alpha 1-Antitrypsin Deficiency - complications ; alpha 1-Antitrypsin Deficiency - drug therapy ; alpha 1-Antitrypsin Deficiency - immunology ; Basic Science Investigations ; Eosinophilia ; Female ; Forced Expiratory Volume - drug effects ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive - drug therapy ; Pulmonary Disease, Chronic Obstructive - immunology ; Registries</subject><ispartof>Respiration, 2018, Vol.95 (2), p.114-121</ispartof><rights>2017 S. Karger AG, Basel</rights><rights>2017 S. Karger AG, Basel.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c1513-a42a06b8b9ea7851ddae3ef4821ca3f2e858d6401a563789d6c4e788a50291d93</citedby><cites>FETCH-LOGICAL-c1513-a42a06b8b9ea7851ddae3ef4821ca3f2e858d6401a563789d6c4e788a50291d93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,2429,4024,27923,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29253843$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Low, Emma V.</creatorcontrib><creatorcontrib>Hughes, Siân M.</creatorcontrib><creatorcontrib>Zaffarullah, Safia</creatorcontrib><creatorcontrib>Kantas, Dimitris</creatorcontrib><creatorcontrib>Stockley, Robert Andrew</creatorcontrib><creatorcontrib>Turner, Alice M.</creatorcontrib><title>ICS Use May Modify FEV1 Decline in α1-Antitrypsin Deficiency Patients with Relatively High Blood Eosinophils</title><title>Respiration</title><addtitle>Respiration</addtitle><description>Background: α 1 -Antitrypsin deficiency (AATD) predisposes to chronic obstructive pulmonary disease (COPD). In COPD unrelated to AATD, the role of a higher blood eosinophil count in disease and subsequent personalization of therapy has recently received much attention. We sought to investigate this concept in patients with AATD-associated COPD. Objectives: The study aims to evaluate eosinophilia status against outcomes including mortality and FEV 1 decline in patients with AATD. Methods: All patients with PiSZ and PiZZ genotypes were identified from the UK AATD registry. The participants were substratified according to inhaled corticosteroid (ICS) use. Blood eosinophil counts were assessed from baseline and annually during follow-up (range 1–18 years). Eosinophilia was defined as a level &gt;0.2 × 10 9 /L, and classified by the frequency of such counts into “always,” “intermittent,” or “never present.” Univariate and multivariate analyses were conducted. Results: In total, 646 participants were included, 53.9% of whom demonstrated intermittent and 7.4% persistent eosinophilia. Survival did not differ according to eosinophilic group (p &gt; 0.05). Those with persistent eosinophilia showed a slower FEV 1 decline (p &lt; 0.001). There was no clear association with exacerbation frequency. Patients on ICS at baseline were more likely to be eosinophilic (p = 0.002) and having a lower FEV 1 (p &lt; 0.001) and greater pack-year exposure (16.5 vs. 7.8 pack-years, p &lt; 0.001). When the multivariate analyses of FEV 1 decline were stratified for baseline ICS use, the association of persistent eosinophilia with slower decline persisted in those on ICS. Conclusions: Blood eosinophil levels persistently &gt;0.2 × 10 9 /L may be an indication for ICS use in PiZZ AATD in order to reduce FEV 1 decline.</description><subject>Administration, Inhalation</subject><subject>Adrenal Cortex Hormones - administration &amp; dosage</subject><subject>Adult</subject><subject>Aged</subject><subject>alpha 1-Antitrypsin Deficiency - complications</subject><subject>alpha 1-Antitrypsin Deficiency - drug therapy</subject><subject>alpha 1-Antitrypsin Deficiency - immunology</subject><subject>Basic Science Investigations</subject><subject>Eosinophilia</subject><subject>Female</subject><subject>Forced Expiratory Volume - drug effects</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pulmonary Disease, Chronic Obstructive - drug therapy</subject><subject>Pulmonary Disease, Chronic Obstructive - immunology</subject><subject>Registries</subject><issn>0025-7931</issn><issn>1423-0356</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kMtOwzAQRS0EoqWwYI-Ql7AIeOw4cZalD1qpFQgo28hNJq0hL-IUlM_iR_gmglq6mrnSuXdxCDkHdgMgg1vGmKtAef4B6YLLhcOE9A5JlzEuHT8Q0CEn1r4xBlIpfkw6POBSKFd0STYdPNOFRTrXDZ0XsUkaOh69Ah1ilJocqcnpzzc4_bw2ddWUts1DTExkMI8a-qjr9qkt_TL1mj5h2uZPTBs6Mas1vUuLIqajoi0V5dqk9pQcJTq1eLa7PbIYj14GE2f2cD8d9GdOBBKEo12umbdUywC1ryTEsUaBias4RFokHJVUsecy0NITvgpiL3LRV0pLxgOIA9EjV9vdsio-NmjrMDM2wjTVORYbG0LgK5-31niLXm_RqCqsrTAJy8pkumpCYOGf3XBvt2Uvd7ObZYbxnvzX2QIXW-BdVyus9sCu_wvU2nzL</recordid><startdate>2018</startdate><enddate>2018</enddate><creator>Low, Emma V.</creator><creator>Hughes, Siân M.</creator><creator>Zaffarullah, Safia</creator><creator>Kantas, Dimitris</creator><creator>Stockley, Robert Andrew</creator><creator>Turner, Alice M.</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2018</creationdate><title>ICS Use May Modify FEV1 Decline in α1-Antitrypsin Deficiency Patients with Relatively High Blood Eosinophils</title><author>Low, Emma V. ; Hughes, Siân M. ; Zaffarullah, Safia ; Kantas, Dimitris ; Stockley, Robert Andrew ; Turner, Alice M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1513-a42a06b8b9ea7851ddae3ef4821ca3f2e858d6401a563789d6c4e788a50291d93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Administration, Inhalation</topic><topic>Adrenal Cortex Hormones - administration &amp; dosage</topic><topic>Adult</topic><topic>Aged</topic><topic>alpha 1-Antitrypsin Deficiency - complications</topic><topic>alpha 1-Antitrypsin Deficiency - drug therapy</topic><topic>alpha 1-Antitrypsin Deficiency - immunology</topic><topic>Basic Science Investigations</topic><topic>Eosinophilia</topic><topic>Female</topic><topic>Forced Expiratory Volume - drug effects</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pulmonary Disease, Chronic Obstructive - drug therapy</topic><topic>Pulmonary Disease, Chronic Obstructive - immunology</topic><topic>Registries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Low, Emma V.</creatorcontrib><creatorcontrib>Hughes, Siân M.</creatorcontrib><creatorcontrib>Zaffarullah, Safia</creatorcontrib><creatorcontrib>Kantas, Dimitris</creatorcontrib><creatorcontrib>Stockley, Robert Andrew</creatorcontrib><creatorcontrib>Turner, Alice M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Respiration</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Low, Emma V.</au><au>Hughes, Siân M.</au><au>Zaffarullah, Safia</au><au>Kantas, Dimitris</au><au>Stockley, Robert Andrew</au><au>Turner, Alice M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>ICS Use May Modify FEV1 Decline in α1-Antitrypsin Deficiency Patients with Relatively High Blood Eosinophils</atitle><jtitle>Respiration</jtitle><addtitle>Respiration</addtitle><date>2018</date><risdate>2018</risdate><volume>95</volume><issue>2</issue><spage>114</spage><epage>121</epage><pages>114-121</pages><issn>0025-7931</issn><eissn>1423-0356</eissn><abstract>Background: α 1 -Antitrypsin deficiency (AATD) predisposes to chronic obstructive pulmonary disease (COPD). In COPD unrelated to AATD, the role of a higher blood eosinophil count in disease and subsequent personalization of therapy has recently received much attention. We sought to investigate this concept in patients with AATD-associated COPD. Objectives: The study aims to evaluate eosinophilia status against outcomes including mortality and FEV 1 decline in patients with AATD. Methods: All patients with PiSZ and PiZZ genotypes were identified from the UK AATD registry. The participants were substratified according to inhaled corticosteroid (ICS) use. Blood eosinophil counts were assessed from baseline and annually during follow-up (range 1–18 years). Eosinophilia was defined as a level &gt;0.2 × 10 9 /L, and classified by the frequency of such counts into “always,” “intermittent,” or “never present.” Univariate and multivariate analyses were conducted. Results: In total, 646 participants were included, 53.9% of whom demonstrated intermittent and 7.4% persistent eosinophilia. Survival did not differ according to eosinophilic group (p &gt; 0.05). Those with persistent eosinophilia showed a slower FEV 1 decline (p &lt; 0.001). There was no clear association with exacerbation frequency. Patients on ICS at baseline were more likely to be eosinophilic (p = 0.002) and having a lower FEV 1 (p &lt; 0.001) and greater pack-year exposure (16.5 vs. 7.8 pack-years, p &lt; 0.001). When the multivariate analyses of FEV 1 decline were stratified for baseline ICS use, the association of persistent eosinophilia with slower decline persisted in those on ICS. Conclusions: Blood eosinophil levels persistently &gt;0.2 × 10 9 /L may be an indication for ICS use in PiZZ AATD in order to reduce FEV 1 decline.</abstract><cop>Basel, Switzerland</cop><pmid>29253843</pmid><doi>10.1159/000481867</doi><tpages>8</tpages></addata></record>
fulltext fulltext
identifier ISSN: 0025-7931
ispartof Respiration, 2018, Vol.95 (2), p.114-121
issn 0025-7931
1423-0356
language eng
recordid cdi_crossref_primary_10_1159_000481867
source MEDLINE; Karger Journals Complete
subjects Administration, Inhalation
Adrenal Cortex Hormones - administration & dosage
Adult
Aged
alpha 1-Antitrypsin Deficiency - complications
alpha 1-Antitrypsin Deficiency - drug therapy
alpha 1-Antitrypsin Deficiency - immunology
Basic Science Investigations
Eosinophilia
Female
Forced Expiratory Volume - drug effects
Humans
Male
Middle Aged
Pulmonary Disease, Chronic Obstructive - drug therapy
Pulmonary Disease, Chronic Obstructive - immunology
Registries
title ICS Use May Modify FEV1 Decline in α1-Antitrypsin Deficiency Patients with Relatively High Blood Eosinophils
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T16%3A06%3A40IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=ICS%20Use%20May%20Modify%20FEV1%20Decline%20in%20%CE%B11-Antitrypsin%20Deficiency%20Patients%20with%20Relatively%20High%20Blood%20Eosinophils&rft.jtitle=Respiration&rft.au=Low,%20Emma%C2%A0V.&rft.date=2018&rft.volume=95&rft.issue=2&rft.spage=114&rft.epage=121&rft.pages=114-121&rft.issn=0025-7931&rft.eissn=1423-0356&rft_id=info:doi/10.1159/000481867&rft_dat=%3Cproquest_cross%3E1978720042%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1978720042&rft_id=info:pmid/29253843&rfr_iscdi=true