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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444 Citations (Scopus)

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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 signiﬁ cantly 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 signiﬁ cantly lower odds of achieving overall asthma control (OR 0·74, 95% CI 0·72–0·77), deﬁ ned 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.

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

Keywords

asthma
eosinophil
control
exacerbations
observational

Access to Document

10.1016/S2213-2600(15)00367-7

Accepted_manuscriptAccepted author manuscript, 2.49 MBLicence: CC BY-NC-ND

Andrew Wilson
- A.M.Wilsonuea.acuk
- Norwich Medical School - Clinical Professor
- Metabolic Health - Member
- Cardiovascular and Metabolic Health - Member
- Respiratory and Airways Group - Member
Person: Research Group Member, Research Centre Member, Academic, Teaching & Research

444 Citations (Scopus)
1 Letter

Inhaled corticosteroid dose-response on blood eosinophils in asthma – Authors' reply
Price, D. B., Pavord, I. D., Thomas, M., Corrigan, C. J., Wilson, A. M., Hillyer, E. V. & Kerkhof, M., 1 Jan 2016, In: The Lancet Respiratory Medicine. 4, 1, p. e1-e2
Research output: Contribution to journal › Letter

1 Citation (Scopus)

Cite this

Price, D. B., Rigazio, A., Campbell, J. D., Bleecker, E. R., Corrigan, C. J., Thomas, M., Wenzel, S. E., Wilson, A. M., Buatti Small, M., 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

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title = "Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study",

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 signiﬁ cantly 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 signiﬁ cantly lower odds of achieving overall asthma control (OR 0·74, 95% CI 0·72–0·77), deﬁ ned 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.",

keywords = "asthma, eosinophil, control, exacerbations, observational",

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

year = "2015",

month = nov,

doi = "10.1016/S2213-2600(15)00367-7",

language = "English",

volume = "3",

pages = "849–858",

journal = "The Lancet Respiratory Medicine",

issn = "2213-2600",

publisher = "Elsevier",

number = "11",

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Price, DB, Rigazio, A, Campbell, JD, Bleecker, ER, Corrigan, CJ, Thomas, M, Wenzel, SE, Wilson, AM, Buatti Small, M, 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

TY - JOUR

T1 - Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study

AU - Price, David B.

AU - Rigazio, Anna

AU - Campbell, Jonathan D.

AU - Bleecker, Eugene R.

AU - Corrigan, Christopher J.

AU - Thomas, Mike

AU - Wenzel, Sally E.

AU - Wilson, Andrew M.

AU - Buatti Small, Mary

AU - Gopalan, Gokul

AU - Ashton, Valerie L.

AU - Burden, Anne

AU - Hillyer, Elizabeth V.

AU - Kerkhof, Marjan

AU - Pavord, Ian D.

PY - 2015/11

Y1 - 2015/11

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 signiﬁ cantly 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 signiﬁ cantly lower odds of achieving overall asthma control (OR 0·74, 95% CI 0·72–0·77), deﬁ ned 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.

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 signiﬁ cantly 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 signiﬁ cantly lower odds of achieving overall asthma control (OR 0·74, 95% CI 0·72–0·77), deﬁ ned 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.

KW - asthma

KW - eosinophil

KW - control

KW - exacerbations

KW - observational

U2 - 10.1016/S2213-2600(15)00367-7

DO - 10.1016/S2213-2600(15)00367-7

M3 - Article

VL - 3

SP - 849

EP - 858

JO - The Lancet Respiratory Medicine

JF - The Lancet Respiratory Medicine

SN - 2213-2600

IS - 11

ER -

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

Abstract

Keywords

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Andrew Wilson

Research output

Inhaled corticosteroid dose-response on blood eosinophils in asthma – Authors' reply

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