Eosinophil counts as a predictor of future COPD exacerbations in the DYNAGITO trial

Background There is conflicting evidence from previous studies as to whether eosinophil counts predict the risk of future exacerbations in COPD. Aims In this post hoc analysis, we investigated the link between baseline eosinophil count and moderate/severe exacerbation rates during the DYNAGITO trial. Methods DYNAGITO was a 52-week, double-blind, randomised trial in patients with COPD with FEV1 Results At baseline, 81% of patients had an eosinophil count ≤300 cells/µL and 49% had an eosinophil count ≤150 cells/µL. 65–76% of patients were receiving ICS across eosinophil subgroups. Similar rates of moderate/severe exacerbations were observed across eosinophil subgroups (figure). Rates were similar across eosinophil counts in patient subgroups with low or high exacerbation history. Conclusions Relatively few patients had an eosinophil count >300 cells/µL, and there was no increase in exacerbation rates with increasing baseline eosinophil count in the total population, or in patients with low or high exacerbation history. In this population, many of whom were receiving ICS, exacerbation history, but not blood eosinophil count, was an important determinant of exacerbation risk.