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Eosinophilic inflammation in Asthma and COPD.
Professor Roland Buhl discusses patient management and the new anti eosinophilic treatment.
Very specific treatments are available for asthma patients with exacerbations and eosinophilic inflammation, thus it is important to correctly diagnose and determine if the severity of exacerbations warrants treatment with a monoclonal antibody. Prof Buhl also notes that effective follow up and monitoring for efficacy and for non-responders are important management goals.
It appears that patients with late onset (i.e., after adolescence) asthmatic disease, patients without clear signs of allergy, patients with high eosinophil counts in blood and sputum – potentially with high concentrations of nitrous oxide in exhaled breath, and patients who frequently require treatment with systemic corticosteroids due to severe uncontrolled asthma are candidates for treatment with monoclonoal antibodies.
In COPD, eosinophilic inflammation is important, but clinical trial data is lacking. There is evidence that in COPD with underlying eosinophilic inflammation, inhaled corticosteroids may have a benefit, but in patients without eosinophilic inflammation, they may not. The data is retrospective or from secondary analyses, hence proper clinical trials need to be conducted before a treatment recommendation can be made.