ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Clinical Implications of Low Absolute Blood Eosinophil Count in the SPIROMICS COPD Cohort
Session Title
TP1 - TP001 MECHANISTIC AND TRANSLATIONAL STUDIES IN COPD
Abstract
A1245 - Clinical Implications of Low Absolute Blood Eosinophil Count in the SPIROMICS COPD Cohort
Author Block: W. B. Lemaster1, P. M. Quibrera2, D. Couper2, D. P. Tashkin1, E. R. Bleecker3, C. M. Doerschuk2, V. E. Ortega4, C. B. Cooper1, M. K. Han5, P. Woodruff6, W. K. O'Neal2, W. H. Anderson2, N. E. Alexis2, J. L. Curtis5, R. P. Bowler7, R. Barr8, R. J. Kaner9, M. T. Dransfield10, R. Paine11, V. Kim12, F. J. Martinez9, A. T. Hastie4, I. Barjaktarevic1; 1Pulmonary and Critical Care Medicine, UCLA, Los Angeles, CA, United States, 2UNC, Chapel Hill, NC, United States, 3Medicine, University of Arizona, Tucson, AZ, United States, 4Wake Forest University, Winston Salem, NC, United States, 5University of Michigan School of Medicine, Ann Arbor, MI, United States, 6Medicine, University of California, San Francisco, San Francisco, CA, United States, 7Natl Jewish Health, Denver, CO, United States, 8Presbyterian Hospital, Columbia University Medical Center, New York, NY, United States, 9Weill Cornell Medical College, New York, NY, United States, 10Univ of Alabama Birmingham & Birmingham VA Med Ctr, Birmingham, AL, United States, 11Univ of Utah, Salt Lake City, UT, United States, 12Thoracic Medicine and Surgery, Temple Lung Center, Philadelphia, PA, United States.
Rationale: The GOLD report recommends considering blood eosinophil counts <100 cells/µM (BEClow) as a predictor of poor response to inhaled corticosteroids (ICS). Using SPIROMICS cohort data we evaluated clinical characteristics of BEClow individuals with COPD in comparison to those without low BEC (BEC100+) and searched for unique predictors of exacerbations.
Methods: 1414 COPD subjects from the SPIROMICS cohort not taking ICS or oral steroids at enrollment into the study were evaluated for a variety of outcomes using multivariate and longitudinal analysis.
Results: We identified 485 BEClow individuals with 61 classified as GOLD group D COPD and 929 individuals with BEC100+ with 124 classified as Group D. Characterization of individuals as BEClow was reproducible based on 6-week retesting in repeatability substudy (N=53, ICC of 0.78) and over one-year follow up (N=1136, ICC of 0.71). BEClow was composed of more current smokers, with less frequent reported history of childhood asthma or use of LAMA, and lower plasma fibrinogen in comparison to BEC100+. In Group D patients with BEClow, current smokers were also more prevalent than among those with BEC100+ (47% vs. 31%, P=0.048). These differences were not observed in multivariable models adjusted for standard demographic variables. BEClow individuals showed faster rate of decline of FEV1 (slope -0.046 vs. -0.038 P<0.00001) but in longitudinal analysis there was no difference in acute exacerbations (AE) over the course of the study (P=0.223), rate of ICS initiation throughout the study (2.5% (12) in BEClow vs 4.4% (41) in BEC100+ P=0.0714), or mortality (7.8% (38) vs 8.4% (78) P=0.79). Focused analysis of Group D individuals showed similar findings. Besides FEV1 and exacerbation history as established predictors of future AE in BEClow group, being non-Caucasian was associated with lower risk of AE (OR 0.40 (95%CI 0.21-0.76) P=0.006), while childhood asthma, a predictor of AE in BEC100+ group, was not (OR 0.72 (95%CI 0.24-2.20) P=0.56).
Conclusion: BEClow individuals represent a heterogeneous cohort characterized by higher prevalence of current smokers and worse decline in lung function in both Group D and overall COPD in comparison to those with non-low blood eosinophil counts. Nevertheless, the BEClow group was not different in terms of occurrence of exacerbations, initiation of ICS, or survival. Our findings highlight the known interactions between low blood eosinophil counts, responsiveness to ICS in terms of preventing exacerbations, and smoking status, emphasizing the importance of adequate interpretation of the role of BEC in the evaluation and management of COPD.
Author Block: W. B. Lemaster1, P. M. Quibrera2, D. Couper2, D. P. Tashkin1, E. R. Bleecker3, C. M. Doerschuk2, V. E. Ortega4, C. B. Cooper1, M. K. Han5, P. Woodruff6, W. K. O'Neal2, W. H. Anderson2, N. E. Alexis2, J. L. Curtis5, R. P. Bowler7, R. Barr8, R. J. Kaner9, M. T. Dransfield10, R. Paine11, V. Kim12, F. J. Martinez9, A. T. Hastie4, I. Barjaktarevic1; 1Pulmonary and Critical Care Medicine, UCLA, Los Angeles, CA, United States, 2UNC, Chapel Hill, NC, United States, 3Medicine, University of Arizona, Tucson, AZ, United States, 4Wake Forest University, Winston Salem, NC, United States, 5University of Michigan School of Medicine, Ann Arbor, MI, United States, 6Medicine, University of California, San Francisco, San Francisco, CA, United States, 7Natl Jewish Health, Denver, CO, United States, 8Presbyterian Hospital, Columbia University Medical Center, New York, NY, United States, 9Weill Cornell Medical College, New York, NY, United States, 10Univ of Alabama Birmingham & Birmingham VA Med Ctr, Birmingham, AL, United States, 11Univ of Utah, Salt Lake City, UT, United States, 12Thoracic Medicine and Surgery, Temple Lung Center, Philadelphia, PA, United States.
Rationale: The GOLD report recommends considering blood eosinophil counts <100 cells/µM (BEClow) as a predictor of poor response to inhaled corticosteroids (ICS). Using SPIROMICS cohort data we evaluated clinical characteristics of BEClow individuals with COPD in comparison to those without low BEC (BEC100+) and searched for unique predictors of exacerbations.
Methods: 1414 COPD subjects from the SPIROMICS cohort not taking ICS or oral steroids at enrollment into the study were evaluated for a variety of outcomes using multivariate and longitudinal analysis.
Results: We identified 485 BEClow individuals with 61 classified as GOLD group D COPD and 929 individuals with BEC100+ with 124 classified as Group D. Characterization of individuals as BEClow was reproducible based on 6-week retesting in repeatability substudy (N=53, ICC of 0.78) and over one-year follow up (N=1136, ICC of 0.71). BEClow was composed of more current smokers, with less frequent reported history of childhood asthma or use of LAMA, and lower plasma fibrinogen in comparison to BEC100+. In Group D patients with BEClow, current smokers were also more prevalent than among those with BEC100+ (47% vs. 31%, P=0.048). These differences were not observed in multivariable models adjusted for standard demographic variables. BEClow individuals showed faster rate of decline of FEV1 (slope -0.046 vs. -0.038 P<0.00001) but in longitudinal analysis there was no difference in acute exacerbations (AE) over the course of the study (P=0.223), rate of ICS initiation throughout the study (2.5% (12) in BEClow vs 4.4% (41) in BEC100+ P=0.0714), or mortality (7.8% (38) vs 8.4% (78) P=0.79). Focused analysis of Group D individuals showed similar findings. Besides FEV1 and exacerbation history as established predictors of future AE in BEClow group, being non-Caucasian was associated with lower risk of AE (OR 0.40 (95%CI 0.21-0.76) P=0.006), while childhood asthma, a predictor of AE in BEC100+ group, was not (OR 0.72 (95%CI 0.24-2.20) P=0.56).
Conclusion: BEClow individuals represent a heterogeneous cohort characterized by higher prevalence of current smokers and worse decline in lung function in both Group D and overall COPD in comparison to those with non-low blood eosinophil counts. Nevertheless, the BEClow group was not different in terms of occurrence of exacerbations, initiation of ICS, or survival. Our findings highlight the known interactions between low blood eosinophil counts, responsiveness to ICS in terms of preventing exacerbations, and smoking status, emphasizing the importance of adequate interpretation of the role of BEC in the evaluation and management of COPD.
