A Comparative Study of Clinical, Hematological, and Biochemical Profiles in Eosinophilic and Non-eosinophilic Phenotypes of Chronic Obstructive Pulmonary Disease (COPD) During Acute Exacerbations

TL;DR

This study compares two types of COPD during flare-ups, finding that patients with higher blood eosinophils have different inflammation and treatment patterns.

Contribution

The study identifies distinct clinical and inflammatory profiles between eosinophilic and non-eosinophilic COPD exacerbations.

Findings

Non-eosinophilic COPD patients had higher inflammation markers and longer hospital stays.

Eosinophilic patients were more likely to receive inhaled corticosteroids.

Very low eosinophil counts correlated with more systemic corticosteroid use.

Abstract

Chronic obstructive pulmonary disease (COPD) continues to be a major global health concern, with emerging evidence suggesting that blood eosinophils may help distinguish between inflammatory subtypes during acute exacerbations. This observational cross-sectional study conducted at Baba Raghav Das (BRD) Medical College, Gorakhpur examined 60 patients with acute COPD exacerbations, categorized into eosinophilic (>300 cells/μL, n=20, 33.1%) and non-eosinophilic (≤300 cells/μL, n=40, 66.9%) phenotypes based on peripheral blood eosinophil counts. Non-eosinophilic patients demonstrated significantly higher systemic inflammation markers, including C-reactive protein levels (17.35 ± 3.8 vs 8.2 ± 5.3 mg/L, p<0.001), neutrophil percentages (79.5 ± 3.5% vs 66.2 ± 4.7%, p<0.001), and hepatic enzymes, along with longer hospital stays (6 vs 4 days, p=0.002). Eosinophilic patients were more likely to receive inhaled corticosteroids (66.0% vs 44.4%), while those with very low eosinophil counts (<150 cells/μL) more frequently received systemic corticosteroids (46.7% vs 19.1%, p=0.023). These findings suggest distinct inflammatory profiles between COPD phenotypes during acute exacerbations and support the potential utility of eosinophil-guided therapeutic approaches, though prospective studies are needed to confirm these associations and their clinical implications.

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