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Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study

Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study
Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study
BACKGROUND: Elevated sputum eosinophil counts predict asthma exacerbations and responsiveness to inhaled corticosteroids but are impractical to measure in primary care. We investigated the relation between blood eosinophil count and prospective annual asthma outcomes for a large UK cohort.

METHODS: This historical cohort study used anonymised medical record data to identify primary care patients with asthma aged 12-80 years with 2 years of continuous records, including 1 year before (baseline) and 1 year after (outcome) their most recent eosinophil count. Negative binomial regression was used to compare outcome exacerbation rates and logistic regression to compare odds of asthma control for patients with blood eosinophil counts of 400 cells per ?L or less versus greater than 400 cells per ?L, adjusting for age, sex, body-mass index, smoking status, and Charlson comorbidity index. The study is registered at ClinicalTrials.gov, number NCT02140541.

FINDINGS: Overall, 20?929 (16%) of 130?248 patients had blood eosinophil counts greater than 400 cells per ?L. During the outcome year, these patients experienced significantly more severe exacerbations (adjusted rate ratio [RR] 1·42, 95% CI 1·36-1·47) and acute respiratory events (RR 1·28, 1·24-1·33) than those with counts of 400 cells per ?L or less. They also had significantly lower odds of achieving overall asthma control (OR 0·74, 95% CI 0·72-0·77), defined as limited reliever use and no asthma-related hospital attendance or admission, acute course of oral corticosteroids, or prescription for antibiotics. Exacerbation rates increased progressively with nine ascending categories of blood eosinophil count as compared with a reference category of 200 cells per ?L or less.

INTERPRETATION: Patients with asthma and blood eosinophil counts greater than 400 cells per ?L experience more severe exacerbations and have poorer asthma control. Furthermore, a count-response relation exists between blood eosinophil counts and asthma-related outcomes. Blood eosinophil counts could add predictive value to Global Initiative for Asthma control-based risk assessment.

FUNDING: Teva Pharmaceuticals.
2213-2600
849-858
Price, D.B.
8efb35a7-5945-45ea-92d1-caa046a37224
Rigazio, A.
c4ff84ae-ea60-4acc-9cf6-b6ea025d91a9
Campbell, J.D.
117b530b-3cc5-47a7-8078-193c26470285
Bleecker, E.R.
aa234ac0-f5f0-4388-91a1-2a32397b44eb
Corrigan, C.J.
d762d0f0-108f-43ac-8160-ac6b3f0b69f9
Thomas, M.
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Wenzel, S.E.
eff0dcb3-9458-4075-9bc7-5dfde43ed477
Wilson, A.M.
fefc4092-c636-42c8-8aa5-7f54b3a672dc
Small, M.B.
9ee0a182-ec75-4ad1-a0b9-ada801f4a64a
Gopalan, G.
c9c1fc7b-5970-4869-8893-029ab474dbd8
Ashton, V.L.
5bf9a679-e3c4-43a1-9daa-09db7428b479
Burden, A.
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Hillyer, E.V.
9f6609c8-3e76-476e-8294-d035ecab0d1f
Kerkhof, M.
7dce98ba-d6fd-4db4-a46c-5a861c361722
Pavord, I.D.
17117111-8a34-4d99-bcc3-879887ed06b8
Price, D.B.
8efb35a7-5945-45ea-92d1-caa046a37224
Rigazio, A.
c4ff84ae-ea60-4acc-9cf6-b6ea025d91a9
Campbell, J.D.
117b530b-3cc5-47a7-8078-193c26470285
Bleecker, E.R.
aa234ac0-f5f0-4388-91a1-2a32397b44eb
Corrigan, C.J.
d762d0f0-108f-43ac-8160-ac6b3f0b69f9
Thomas, M.
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Wenzel, S.E.
eff0dcb3-9458-4075-9bc7-5dfde43ed477
Wilson, A.M.
fefc4092-c636-42c8-8aa5-7f54b3a672dc
Small, M.B.
9ee0a182-ec75-4ad1-a0b9-ada801f4a64a
Gopalan, G.
c9c1fc7b-5970-4869-8893-029ab474dbd8
Ashton, V.L.
5bf9a679-e3c4-43a1-9daa-09db7428b479
Burden, A.
8f6413f0-daaa-4e59-9a83-7de5f0f3315d
Hillyer, E.V.
9f6609c8-3e76-476e-8294-d035ecab0d1f
Kerkhof, M.
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Pavord, I.D.
17117111-8a34-4d99-bcc3-879887ed06b8

Price, D.B., Rigazio, A., Campbell, J.D., Bleecker, E.R., Corrigan, C.J., Thomas, M., Wenzel, S.E., Wilson, A.M., Small, M.B., Gopalan, G., Ashton, V.L., Burden, A., Hillyer, E.V., Kerkhof, M. and Pavord, I.D. (2015) Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study. The Lancet Respiratory Medicine, 3 (11), 849-858. (doi:10.1016/S2213-2600(15)00367-7). (PMID:26493938)

Record type: Article

Abstract

BACKGROUND: Elevated sputum eosinophil counts predict asthma exacerbations and responsiveness to inhaled corticosteroids but are impractical to measure in primary care. We investigated the relation between blood eosinophil count and prospective annual asthma outcomes for a large UK cohort.

METHODS: This historical cohort study used anonymised medical record data to identify primary care patients with asthma aged 12-80 years with 2 years of continuous records, including 1 year before (baseline) and 1 year after (outcome) their most recent eosinophil count. Negative binomial regression was used to compare outcome exacerbation rates and logistic regression to compare odds of asthma control for patients with blood eosinophil counts of 400 cells per ?L or less versus greater than 400 cells per ?L, adjusting for age, sex, body-mass index, smoking status, and Charlson comorbidity index. The study is registered at ClinicalTrials.gov, number NCT02140541.

FINDINGS: Overall, 20?929 (16%) of 130?248 patients had blood eosinophil counts greater than 400 cells per ?L. During the outcome year, these patients experienced significantly more severe exacerbations (adjusted rate ratio [RR] 1·42, 95% CI 1·36-1·47) and acute respiratory events (RR 1·28, 1·24-1·33) than those with counts of 400 cells per ?L or less. They also had significantly lower odds of achieving overall asthma control (OR 0·74, 95% CI 0·72-0·77), defined as limited reliever use and no asthma-related hospital attendance or admission, acute course of oral corticosteroids, or prescription for antibiotics. Exacerbation rates increased progressively with nine ascending categories of blood eosinophil count as compared with a reference category of 200 cells per ?L or less.

INTERPRETATION: Patients with asthma and blood eosinophil counts greater than 400 cells per ?L experience more severe exacerbations and have poorer asthma control. Furthermore, a count-response relation exists between blood eosinophil counts and asthma-related outcomes. Blood eosinophil counts could add predictive value to Global Initiative for Asthma control-based risk assessment.

FUNDING: Teva Pharmaceuticals.

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More information

e-pub ahead of print date: 20 October 2015
Published date: November 2015
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 388224
URI: http://eprints.soton.ac.uk/id/eprint/388224
ISSN: 2213-2600
PURE UUID: 7063668c-fc55-46de-95e5-489a60f2c422

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Date deposited: 22 Feb 2016 12:06
Last modified: 14 Mar 2024 22:54

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Contributors

Author: D.B. Price
Author: A. Rigazio
Author: J.D. Campbell
Author: E.R. Bleecker
Author: C.J. Corrigan
Author: M. Thomas
Author: S.E. Wenzel
Author: A.M. Wilson
Author: M.B. Small
Author: G. Gopalan
Author: V.L. Ashton
Author: A. Burden
Author: E.V. Hillyer
Author: M. Kerkhof
Author: I.D. Pavord

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