Comprehensive Care Management in Conjunction with Sputum Cytometry-Guided Pharmacotherapy in a Post-Discharge Clinic for Patients with COPD

Figures & data

Table 1. Sputum-guided treatment algorithm.

	Sputum Eosinophils			Sputum Neutrophils
Intervention	<1%	1–2%	>2%	Total count > 12 million cells/gram
Inhaled corticosteroid	Decrease anti-inflammatory	No change in anti-inflammatory	Increase anti-inflammatory*
Antibiotic				Oral broad-spectrum or targeted treatment**

Adapted from Siva et al. [18].

* If patients had sputum eosinophilia and met criteria for acute exacerbation, they were given a course of Prednisone.

** Targeted treatment based on culture and sensitivities.

Table 2. Anti-inflammatory hierarchy.

Anti-inflammatory
No treatment
ICS < 500 mcg
ICS < 1000 mcg ICS < 2000 mcg
Prednisone 5 mg daily
Prednisone 10 mg daily
Prednisone 15 mg daily
ICS doses are fluticasone propionate equivalents per day. Adapted from Siva et al. [18]. ICS, inhaled corticosteroid.

Table 3. Baseline characteristics of patient cohort.

Characteristic
Age	69.1 (9.50)
Male Sex n (%)	41(40.6)
Currently Smoking n (%)	41(40.6)
Pack-Year History	52.1 (30.8)
Number of Follow -Up Visits	2 (1,3)
FEV1 % predicted	42.8 (19.3)
Exacerbations in last 12 months	2 (1,3.5)
Peripheral blood eosinophils (10^6/mL)	0.1 (0,0.3)
mMRC score at Visit 1 (%)
0	13.2
1	22.0
2	18.6
3	17.6
4	28.6
CAT score at Visit 1 (%)
0–10	13.8
10–20	36.3
20–30	30.0
30–40	20.0
GOLD Class n (%)
C	13(12.9)
D	88(87.1)
Inhaled Medications n(%)
No maintenance inhalers	2 (1.9)
LAMA Monotherapy	4 (4.0)
ICS/LABA	8 (7.9)
ICS/LAMA	1 (1.0)
LAMA/LABA	11 (10.9)
ICS/LABA/LAMA	75 (74.3)
Home oxygen n(%)	33 (32.7)
Home noninvasive ventilation n(%)	12 (11.9)
Comorbidities n (%)
Congestive heart failure	17 (16.8)
Asthma	26 (25.7)
Mood/Anxiety disorder	43 (42.6)
Pulmonary hypertension	4 (4.0)
Data are presented as mean (SD), median (Q1,Q3), or Number (%). FEV1 forced expiratory volume in 1 s, mMRC modified medical research council dyspnea scale, CAT COPD assessment test, LAMA long-acting muscarinic antagonist, ICS inhaled corticosteroid, LABA long-acting beta agonist.

Figure 1. Clinic and sputum feasibility. Includes the number of patients referred to and attending the COPD post-discharge clinic, as well as the number able to provide a sputum sample adequate for analysis and the number of patients with abnormal sputum.

Figure 2. Prevalence of specific types of airway inflammation as measured in sputum.

Table 4. Summary of healthcare utilization in the 6-months prior to and after Clinic Visit 1.

Outcome	Incidence Rate Ratio	95% Confidence Interval	p-value
COPD-related healthcare utilization	0.26	(0.21, 0.32)	<0.001
All-cause healthcare utilization	0.29	(0.22, 0.37)	<0.001
COPD chronic obstructive pulmonary disease.

Siva R, Green RH, Brightling CE, et al. Eosinophilic airway inflammation and exacerbations of COPD: a randomised controlled trial. Eur Respir J. 2007;29(5):906–913. DOI:10.1183/09031936.00146306

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