Letter to the Editor
Eosinophils and Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease
Eosinófilos y corticoides inhalados en la enfermedad pulmonar obstructiva crónica
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Fernández" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212916301847" "doi" => "10.1016/j.arbr.2016.07.026" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916301847?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616301764?idApp=UINPBA00003Z" "url" => "/03002896/0000005200000010/v3_201609300128/S0300289616301764/v3_201609300128/es/main.assets" ] ] "itemAnterior" => array:19 [ "pii" => "S1579212916301707" "issn" => "15792129" "doi" => "10.1016/j.arbr.2016.04.007" "estado" => "S300" "fechaPublicacion" => "2016-10-01" "aid" => "1390" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch 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Corticosteroids in Chronic Obstructive Pulmonary Disease" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "541" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Adolfo Baloira Villar, Abel Pallarés Sanmartín, Marta Núñez Fernández" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Adolfo Baloira" "apellidos" => "Villar" "email" => array:1 [ 0 => "adolfo.baloira.villar@sergas.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Abel Pallarés" "apellidos" => "Sanmartín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Marta Núñez" "apellidos" => "Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Complejo Hospitalario Universitario de Pontevedra, Casas Novas, Pontevedra, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eosinófilos y corticoides inhalados en la enfermedad pulmonar obstructiva crónica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We welcome and largely agree with the comments on our recent article.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Further insight is needed into the role played by blood eosinophilia in the management of chronic obstructive pulmonary disease (COPD). Perhaps the most important aspect to clarify is the absolute or relative number of eosinophils needed for either prognostic or therapeutic purposes, or even to define a potential new COPD phenotype. As the authors point out, most of the studies conducted to date consist of <span class="elsevierStyleItalic">post hoc</span> analyses; however, all report the same results, namely, significant response to inhaled corticosteroids is only achieved with certain blood eosinophil levels. We wrote our scientific letter over 1 year ago, and since then new studies have contributed further evidence in support of this finding. A re-analysis of the results of the ISOLDE study showed the FEV1 decline was reduced by around 34<span class="elsevierStyleHsp" style=""></span>mL/year in patients with eosinophil count ≥2% at the start of the study, while no difference in decline was observed with <2%.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Another approach to this issue was taken in the <span class="elsevierStyleItalic">post hoc</span> analysis of the WISDOM trial, where exacerbations were observed to increase after withdrawal of fluticasone in patients with eosinophil counts of ≥2%, with a relative risk (RR) of 1.22. The increase in the exacerbation rate became more pronounced as the eosinophil cutoff level rose (≥ 4%, RR: 1.63; ≥5%, RR: 1.82).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In conclusion, although we agree with most of the authors’ comments, we believe that evidence has shown blood eosinophil levels to be an excellent biomarker of response to inhaled corticosteroids in COPD, and could even constitute a specific COPD phenotype.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Villar AB, Sanmartín AP, Fernández MN. Eosinófilos y corticoides inhalados en la enfermedad pulmonar obstructiva crónica. Arch Bronconeumol. 2016;52:541.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Corticoides inhalados, eosinófilos y exacerbaciones de enfermedad pulmonar obstructiva crónica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Golpe" 1 => "I. Martín-Robles" 2 => "P. Sanjuán-López" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2015.06.004" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2016" "volumen" => "52" "paginaInicial" => "229" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26216714" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109799004891" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood eosinophils as a marker of response to inhaled corticosteroids in COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N.C. Barnes" 1 => "R. Sharma" 2 => "S. Lettis" 3 => "P.M. Calverley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.01370-2015" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2016" "volumen" => "47" "paginaInicial" => "1374" "paginaFinal" => "1382" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26917606" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood eosinophil count and exacerbations in severe chronic obstructive pulmonary disease after withdrawal of inhaled corticosteroids: a post-hoc analysis of the WISDOM trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Watz" 1 => "K. Tetzlaff" 2 => "E.F. Wouters" 3 => "A. Kirsten" 4 => "H. Magnussen" 5 => "R. Rodríguez-Roisin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S2213-2600(13)70187-5" "Revista" => array:3 [ "tituloSerie" => "Lancet Respir Med" "fecha" => "2016" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24429275" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enfermedad pulmonar obstructiva crónica con eosinofilia, ¿un fenotipo emergente?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Baloira Villar" 1 => "A. Pallarés Sanmartín" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2015.11.015" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2016" "volumen" => "52" "paginaInicial" => "177" "paginaFinal" => "178" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26852358" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000010/v2_201609300109/S1579212916301847/v2_201609300109/en/main.assets" "Apartado" => array:4 [ "identificador" => "45358" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000010/v2_201609300109/S1579212916301847/v2_201609300109/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916301847?idApp=UINPBA00003Z" ]
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