In patients with COPD, an elevated blood eosinophil count combined with a high exacerbation burden defines a distinct clinical subgroup that warrants a targeted pharmacological approach.
This protocol applies to patients with COPD classified as high-risk eosinophilic phenotype: blood eosinophils ≥ 300 cells/µL, with two or more moderate exacerbations in the previous year, or at least one exacerbation requiring hospitalisation.
Current evidence supports initiating a combined inhaled regimen that addresses both bronchodilation and eosinophilic airway inflammation in a single device.
Full regimen details, agent selection, and escalation criteria are in the complete protocol.DOI: 10.3390/jcm13020303
On the other hand, patients at high risk should be differentiated by phenotype: in the case of a non-acute and non-eosinophilic patient, treatment should be initiated with LABA + LAMA, and in the case of an eosinophilic patient, treatment should be initiated with IC + LABA (Figure 1).
Also, it proposes to initiate triple therapy (LABA + LAMA + IC) in patients with ≥300/µL blood eosinophils consistently and two or more moderate exacerbations or in those whose onset required an admission (Figure 2).
High-risk patients on dual bronchodilation may need triple therapy (LABA + LAMA + CI) in a single inhaler (Figure 1).
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