CHEST Guidelines-Rebuttal-From-Dr-Criner

Rebuttal-From-Dr-Criner_chest

Pdf Summary

The discussion centers on using precision medicine to guide clinical decisions for COPD patients, particularly through monitoring eosinophil levels. Dr. Criner cautions against heavy reliance on post hoc clinical trial data. However, recent trials like IMPACT and CORTICO-COP support the use of eosinophils to tailor patient care. While some research suggests that elevated eosinophil levels might improve outcomes, trials targeting IL-5 pathways saw reduced eosinophil levels with negligible impact on symptoms or quality of life, indicating that suppression within normal levels may not pose significant risks.<br /><br />The complexity of utilizing peripheral blood eosinophil (PBE) levels in COPD management is a focal point. PBE may reflect inflammation types or could be influenced by microbiome interactions and underlying conditions like emphysema. Understanding eosinophil roles in the lung beyond blood measures is vital, as PBE levels only indicate potential treatment effects, not exact treatment thresholds.<br /><br />Post hoc analyses of GALATHEA and TERRANOVA trials suggest that benralizumab effectively reduces PBE but not necessarily exacerbations or lung function. These analyses indicate identifying COPD patients more likely to benefit from such treatment when combining PBE levels with clinical characteristics like exacerbation history and lung function isn't straightforward.<br /><br />The text underscores the need for further research on eosinophilic inflammation, considering factors like sex, race, and comorbidities, and calls for more rigorous clinical trials. In current practice, physicians may consider eosinophil levels alongside other clinical information for decision-making about using inhaled or systemic corticosteroids, emphasizing individualized care fitting each patient’s clinical profile.

Keywords

precision medicine

COPD

eosinophil levels

clinical decisions

IMPACT trial

CORTICO-COP trial

IL-5 pathways

peripheral blood eosinophil

benralizumab

individualized care