Mesa 2. Control y Biomarcadores en EPOC

1. Mesa 2. Control y biomarcadores
Dr. José Luis
López-Campos
Hospital Virgen del Rocío. Sevilla

2. Mesa 2. Control y biomarcadores
[ATS] Symptom Burden Of
COPD Patients - Real Life
Data From The German
Daccord Registry
Buhl R, Criee CP, Kardos P,
Vogelmeier CF,
Worth H

3. Mesa 2. Control y biomarcadores
Introduction
Patients’ symptoms are the key parameters that drive therapeutic
interventions in COPD. (O’Hagan P. et al., Curr Med Res Opin 2014;
30:301–14). So far, limited data have been published on COPD symptoms.
Methods
In the prospective, real-life DACCORD registry, 6,208 patients with COPD
completed mMRC and CAT questionnaires and reported their COPD
symptoms and co-morbidities at baseline.

4. Mesa 2. Control y biomarcadores
Results
Mean age of the patients was 65.7 years (range 40-96 years), 45 % were younger than 65
years and 59.6 % were males. The number of patients reporting ≥1 exacerbation in the 6
months prior to documentation was 28 %.
• Free of symptoms : 3 %
• Dyspnea on exertion: 85 %
• Cough: 65 %, of these:
• Dry cough: 39 %
• Wet cough: 61 %
• Limitations of exercise tolerance 55 %
• Other: dyspnea at rest, chest tightness, wheezing or prolonged expiration: 20 %

5. Mesa 2. Control y biomarcadores
Results
In subgroup analyses, patients with CAT <10 reported fewer symptoms than
patients with CAT >30

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Results
The vast majority of patients (>90 %) was primarily symptomatic during
daytime and in the morning.
The most common co-morbidity was cardiovascular disease (CD, 52 % of
total population).
In patients with CAT >30, the second most frequent co-morbidity were
psychiatric disorders with a 4-fold higher incidence compared to patients
with CAT < 10 (23,7 % vs 5,5 % respectively).

7. Mesa 2. Control y biomarcadores
Conclusion
This extensive real-world study in Germany provides insights into COPD
symptoms in a large patient population of over 6.000 patients. The most
frequent COPD symptom reported was dyspnea on exertion. Patients with
CAT <10 reported fewer comorbidities than patients with CAT >30. In a
majority of patients, symptoms occur in the morning or during daytime and
CD is the most common comorbidity.

8. Mesa 2. Control y biomarcadores
[ATS] Stable Blood
Eosinophil Percentage
Predicts Exacerbation
Recovery In COPD
Donaldson GC, Mackay AJ,
Whitmore GA, Aaron SD,
Wedzicha JA

9. Mesa 2. Control y biomarcadores
Rationale
A recent study has shown non-inferiority of blood eosinophilia at
exacerbation to guide treatment of COPD exacerbations with oral
corticosteroids (Bafadhel et al. AJRCCM 2012;186:48-55).
It was unclear whether eosinophil count measured at baseline (stable) or
exacerbation would be the best indicator as 80 % of patients with ≥ 2 %
eosinophil count at exacerbation had ≥ 2 % at baseline.
We examined in exacerbations treated with oral corticosteroids, whether the
percentage of eosinophils in blood sampled at baseline was predictive of
exacerbation duration.

10. Mesa 2. Control y biomarcadores
Methods
This study consists of data collected from the London COPD cohort between 3/10/2005 and
the 21/3/2014. COPD was defined as FEV1 <80 %, FEV1 / FVC ratio <0,7. Exacerbations
were defined as the first of two or more days in which the patient recorded two or more new
or worsening respiratory symptoms that had to include dyspnoea, sputum purulence or
sputum volume. Exacerbation duration was defined as the number of days from onset until
two consecutive days without worse than normal respiratory symptoms.
To allow for repeated measures this analysis was performed with shared frailty survival
models. A stable blood sample was collected 4 weeks after and 2 weeks before the onset of
any exacerbation.

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Results
184 COPD patients had at least one oral corticosteroid treated
exacerbation. Their mean FEV1 was 1.22 l (SD 0.49); FEV1 % predicted,
49.2 % (16.1); FEV1 /FVC ratio, 0.46 (0.12); age 70.1 (8.6); 61.5 % male.
There were an average 10.2 stable blood samples per patient: 61 patients
had an average eosinophil count < 2 % eosinophils and 123 patients ≥ 2 %.
No significant differences were seen between these two groups with the
median annual exacerbation frequency in patients <2 % was 2.62 per year
(IQR 1.96-3.8) and for patients ≥ 2 %, 2.54 per year (IQR 1.7-3.8; negative
binomial regression p=0.89).

12. Mesa 2. Control y biomarcadores
Results
The 184 patients had 991 oral corticosteroid treated exacerbations (average
5.4 per patient) for which the duration of the exacerbation was known.
A raised stable eosinophil count was associated with a shorter exacerbation
time; hazard ratio =1.34 (95 % CI 1.10-1.65; p=0.004; see figure 1).
The median exacerbations duration in patient <2 % and ≥ 2 % was 13.5
days (IQR 8-26) and 11 days respectively (IQR 7-18; Wilcoxon; p=0.001).

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Conclusion
The results suggest that a stable eosinophil count may be able to classify
patients prior to exacerbation presentation into whether they will have
shorter exacerbations in response to oral corticosteroid therapy. This
classification will be useful when rapid blood analysis is unavailable.

15. Mesa 2. Control y biomarcadores
[ERS] Long-term effects of
inhaled corticosteroids on
sputum bacterial and viral
loads in COPD patients
Contoli M, Pauletti A, Casolari P,
Hnesini G, Magnoni MS, Currandi G,
et al.

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Rationale
The use of inhaled corticosteroid (ICS) in COPD reduces the risk of exacerbations
but it is associated with increased risk of pneumonia
Objectives
We compared the effects of 1-year treatment with either fluticasone
propionate/salmeterol (SALM/FP) or salmeterol (SALM) alone on sputum bacterial
and viral loads in moderate COPD patients

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Methods
60 stable moderate COPD patients were recruited and randomized to receive
either SALM/FP 50/500 mcg bid or SALM 50 mcg bid for 12 months. After
baseline assessment, patients were seen every 3 months. At each visit lung
function was assessed and induced sputum collected to evaluate the
inflammatory cell profile and quantitative/qualitative bacteriology/virology

18. Mesa 2. Control y biomarcadores
Results
After 1-year treatment, sputum total bacterial load significantly increased in the
SALM/FP group (D +1.3 [-3 – 5] Log10 CFU/ml, p < 0.01) but not in the SALM
group (D0 [-5 – 4] Log10 CFU/ml, p > 0.05). A non-significant increase of
potentially pathogen bacterial load was observed in sputum samples of
SALM/FP treated patients. No difference in respiratory virus detection rate was
observed between the two arms. The increase in airway total bacterial load did
not correlate with any of the clinical outcomes assessed during the study.
Among SALM/FP treated patients, the increase in total bacterial load occurred
in those subjects with no sputum eosinophil detection throughtout the study
(p=ns)

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Conclusions
In moderate COPD patients ICS-treatment is associated with a significant
increase in airway total bacterial load, not related to clinical outcomes, when
eosinophils are persistently absent in sputum samples.

20. Mesa 2. Control y biomarcadores
Muchas gracias
por su atención