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

David B Price; Anna Rigazio; Jonathan D Campbell; Eugene R Bleecker; Christopher J Corrigan; Mike Thomas; Sally E Wenzel; Andrew M Wilson; Mary Buatti Small; Gokul Gopalan; Valerie L Ashton; Anne Burden; Elizabeth V Hillyer; Marjan Kerkhof; Ian D Pavord

doi:10.1016/S2213-2600(15)00367-7

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

David B Price, Anna Rigazio, Jonathan D Campbell, Eugene R Bleecker, Christopher J Corrigan, Mike Thomas, Sally E Wenzel, Andrew M Wilson, Mary Buatti Small, Gokul Gopalan, Valerie L Ashton, Anne Burden, Elizabeth V Hillyer, Marjan Kerkhof, Ian D Pavord

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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 μL or less versus greater than 400 cells per μL, 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 μL. 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 μL 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 μL or less.

INTERPRETATION: Patients with asthma and blood eosinophil counts greater than 400 cells per μL 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.

Original language	English
Pages (from-to)	849-858
Number of pages	10
Journal	The Lancet. Respiratory medicine
Volume	3
Issue number	11
Early online date	19 Oct 2015
DOIs	https://doi.org/10.1016/S2213-2600(15)00367-7
Publication status	Published - Nov 2015

Bibliographical note

Copyright © 2015 Elsevier Ltd. All rights reserved.
Funding: Teva Pharmaceuticals.

Keywords

Asthma
Blood Eosinophil Count

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10.1016/S2213-2600(15)00367-7Licence: Unspecified

David Price
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Chair of Primary Care Respiratory Med
- Institute of Applied Health Sciences
Person: Clinical Academic Related - Scholarship, Clinical Academic

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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., & 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. https://doi.org/10.1016/S2213-2600(15)00367-7

Price, DB, Rigazio, A, Campbell, JD, Bleecker, ER, Corrigan, CJ, Thomas, M, Wenzel, SE, Wilson, AM, Small, MB, Gopalan, G, Ashton, VL, Burden, A, Hillyer, EV, Kerkhof, M & Pavord, ID 2015, 'Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study', The Lancet. Respiratory medicine, vol. 3, no. 11, pp. 849-858. https://doi.org/10.1016/S2213-2600(15)00367-7

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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 μL or less versus greater than 400 cells per μL, 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 μL. 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 μL 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 μL or less.INTERPRETATION: Patients with asthma and blood eosinophil counts greater than 400 cells per μL 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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AU - Corrigan, Christopher J

AU - Thomas, Mike

AU - Wenzel, Sally E

AU - Wilson, Andrew M

AU - Small, Mary Buatti

AU - Gopalan, Gokul

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N2 - 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 μL or less versus greater than 400 cells per μL, 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 μL. 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 μL 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 μL or less.INTERPRETATION: Patients with asthma and blood eosinophil counts greater than 400 cells per μL 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.

AB - 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 μL or less versus greater than 400 cells per μL, 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 μL. 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 μL 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 μL or less.INTERPRETATION: Patients with asthma and blood eosinophil counts greater than 400 cells per μL 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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Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study

Abstract

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