The acute wheezy adult with airways disease in the emergency department: a retrospective case-note review of exacerbations of COPD

Abstract

Introduction: There has been an increase in interest in the peripheral blood eosinophil count as a biomarker in COPD. Few studies have examined the eosinophil count in patients attending the emergency department (ED) with acute exacerbations of COPD (AECOPD). We investigated the relationship between the blood eosinophil and other variables collected routinely at ED presentation and outcomes.

Methods: Retrospective case note review of patients attending the ED with an AECOPD over 18 months. Demographic, clinical and pharmacological data were analyzed at the time of presentation, and clinical outcomes relating to hospital admission, length of hospital stay and mortality were investigated.

Results: There were 743 AECOPD index events in 537 patients. Over half (57%) of all attendees were admitted to hospital. They were older, reported an increased number of exacerbations and higher levels of total leukocytes and neutrophils. Length of stay was shorter in patients with a blood eosinophil count ≥2% compared to <2% (median (IQR) 3 days (1–7) vs 4 days (2–8) respectively, p<0.05). Length of stay correlated with peripheral blood neutrophils (r=0.12, p=0.021), peripheral blood absolute and relative eosinophils (r=−0.12, p=0.024 and r=−0.11, p=0.035, respectively) and CRP (r=0.16, p=0.027). Non-eosinophilic AECOPD were associated with an increased risk of mortality during an exacerbation (χ² 5.9, OR 3.08, 95% CI 1.19–7.96, p=0.015).

Conclusion: In exacerbations of COPD presenting to ED, a higher blood eosinophil count is associated with a shorter length of stay and reduced mortality.

Keywords:

• COPD
• exacerbation
• eosinophils
• mortality
• predictors

Acknowledgments

This study is funded by the NIHR Biomedical Research Centre, Oxford, UK and the NIHR Collaboration for Leadership in Applied Health Research and Care, Oxford, UK.

Author contributions

All authors made substantial contributions to concept and design of the study and both the acquisition and analysis of the data. Each was involved in the drafting of the manuscript and have revised it prior to submission. The authors have approved for the manuscript to be published and agreed to take full responsibility for the accuracy, integrity and probity of the work.

Disclosure

ID Pavord reports grants, personal fees, and in the last 5 years has received speaker’s honoraria for speaking at sponsored meetings from Astra Zeneca (AZ), Boehringer Ingelheim, Aerocrine, Almirall, Novartis, Teva, Chiesi and GSK and payments for organizing educational events from AZ and Teva. He has received honoraria for attending advisory panels with Genentech, Regeneron, AZ, Boehringer Ingelheim, GSK, Novartis, Teva, Merck, Sanofi, Circassia, Chiesi and Knopp. He has also received sponsorship to attend international scientific meetings from Boehringer Ingelheim, GSK, AZ, Teva and Chiesi. In addition, he has received a grant from Chiesi to support a phase 2 clinical trial in Oxford, outside the submitted work. The authors report no other conflicts of interest in this work.