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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In a recent edition of <span class="elsevierStyleSmallCaps">Archivos de Bronconeumolog&#237;a</span>&#44; Baloira Villar et al&#46; discussed the consensus on the use of inhaled corticosteroids &#40;ICS&#41; in chronic obstructive pulmonary disease &#40;COPD&#41;&#44; and made some interesting comments&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In line with other authors&#44; they suggest&#44; in their last paragraph&#44; that eosinophilia is currently the best marker for ICS response in COPD&#46; However&#44; we believe that some clarification is necessary&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">It is true that&#44; at the moment&#44; eosinophilia in sputum appears to be the most reliable predictor of therapeutic response&#44; but it is a technically complex test that can only be performed in a few hospitals in Spain&#44; so is of little general use&#46; Several recent studies have evaluated the possibility of using blood eosinophilia as more accessible biomarker for predicting response to the combination of long-acting beta-antagonists &#40;LABA&#41; and ICS in COPD in terms of reducing exacerbations&#46; This marker appears to have an acceptable correlation with sputum eosinophilia&#44; and results have been promising&#46; The most commonly used cut-off point is &#8805;2&#37; eosinophils&#46; However&#44; practically all these reports consist of <span class="elsevierStyleItalic">post hoc</span> analyses of clinical trials in which the evaluation of eosinophilia and its relationship with therapeutic response was not an initial study objective&#44; so these results must be viewed with caution&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The relationship between blood eosinophilia and the risk of exacerbation has not yet been clarified&#44; nor has the best cut-off point for eosinophils been determined&#46; In a recent article&#44; eosinophil levels &#8805;2&#37; predicted severe exacerbations in COPD patients&#44; but paradoxically&#44; the rate of moderate exacerbations was lower in patients with eosinophil values above this limit&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> However&#44; a different measurement &#40;340<span class="elsevierStyleHsp" style=""></span>eosinophils&#47;&#956;l&#41; showed that patients who exceeded these values developed more moderate and severe exacerbations&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> It is thus difficult at present to apply these findings in clinical practice&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Furthermore&#44; the analytical tests used in the clinical trials cited were based on blood eosinophil levels determined at the time of patient recruitment to predict exacerbations in the immediate post-test period&#44; which can vary widely&#44; while a study derived from the ECLIPSE cohort showed that 49&#37; of patients had eosinophil counts ranging above and below 2&#37; throughout the study&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> This raises new questions for clinicians&#44; such as the possibility that ICS might &#40;or must&#41; be withdrawn or reinitiated during follow-up&#44; depending on the evolution of eosinophil levels&#46; Such questions can only be answered with specifically designed studies addressing these issues&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In summary&#44; blood eosinophilia is a promising biomarker in COPD&#44; but we are far from being able to use it to safely determine treatment for stable-phase COPD&#44; and it seems likely that in the future it will be combined with other markers&#44; such as periostin&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> We agree with Baloira Villar et al&#46; in their final conclusion&#58; COPD is a highly heterogenic disease&#44; and more biomarkers are needed to help us tailor treatment&#46;</p></span>"
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Letter to the Editor
Inhaled Corticosteroids, Eosinophils and Chronic Obstructive Pulmonary Disease Exacerbations
Corticoides inhalados, eosinófilos y exacerbaciones de la enfermedad pulmonar obstructiva crónica
Rafael Golpe
Corresponding author
rafagolpe@gmail.com

Corresponding author.
, Irene Martín-Robles, Pilar Sanjuán-López
Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In a recent edition of <span class="elsevierStyleSmallCaps">Archivos de Bronconeumolog&#237;a</span>&#44; Baloira Villar et al&#46; discussed the consensus on the use of inhaled corticosteroids &#40;ICS&#41; in chronic obstructive pulmonary disease &#40;COPD&#41;&#44; and made some interesting comments&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In line with other authors&#44; they suggest&#44; in their last paragraph&#44; that eosinophilia is currently the best marker for ICS response in COPD&#46; However&#44; we believe that some clarification is necessary&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">It is true that&#44; at the moment&#44; eosinophilia in sputum appears to be the most reliable predictor of therapeutic response&#44; but it is a technically complex test that can only be performed in a few hospitals in Spain&#44; so is of little general use&#46; Several recent studies have evaluated the possibility of using blood eosinophilia as more accessible biomarker for predicting response to the combination of long-acting beta-antagonists &#40;LABA&#41; and ICS in COPD in terms of reducing exacerbations&#46; This marker appears to have an acceptable correlation with sputum eosinophilia&#44; and results have been promising&#46; The most commonly used cut-off point is &#8805;2&#37; eosinophils&#46; However&#44; practically all these reports consist of <span class="elsevierStyleItalic">post hoc</span> analyses of clinical trials in which the evaluation of eosinophilia and its relationship with therapeutic response was not an initial study objective&#44; so these results must be viewed with caution&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The relationship between blood eosinophilia and the risk of exacerbation has not yet been clarified&#44; nor has the best cut-off point for eosinophils been determined&#46; In a recent article&#44; eosinophil levels &#8805;2&#37; predicted severe exacerbations in COPD patients&#44; but paradoxically&#44; the rate of moderate exacerbations was lower in patients with eosinophil values above this limit&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> However&#44; a different measurement &#40;340<span class="elsevierStyleHsp" style=""></span>eosinophils&#47;&#956;l&#41; showed that patients who exceeded these values developed more moderate and severe exacerbations&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> It is thus difficult at present to apply these findings in clinical practice&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Furthermore&#44; the analytical tests used in the clinical trials cited were based on blood eosinophil levels determined at the time of patient recruitment to predict exacerbations in the immediate post-test period&#44; which can vary widely&#44; while a study derived from the ECLIPSE cohort showed that 49&#37; of patients had eosinophil counts ranging above and below 2&#37; throughout the study&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> This raises new questions for clinicians&#44; such as the possibility that ICS might &#40;or must&#41; be withdrawn or reinitiated during follow-up&#44; depending on the evolution of eosinophil levels&#46; Such questions can only be answered with specifically designed studies addressing these issues&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In summary&#44; blood eosinophilia is a promising biomarker in COPD&#44; but we are far from being able to use it to safely determine treatment for stable-phase COPD&#44; and it seems likely that in the future it will be combined with other markers&#44; such as periostin&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> We agree with Baloira Villar et al&#46; in their final conclusion&#58; COPD is a highly heterogenic disease&#44; and more biomarkers are needed to help us tailor treatment&#46;</p></span>"
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Article information
ISSN: 15792129
Original language: English
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