Treatment of High-Risk COPD with Low Blood Eosinophils (Non-Eosinophilic, < 300 cells/µL)
This protocol covers chronic obstructive pulmonary disease patients who are classified as high risk and have a non-eosinophilic blood profile — a specific phenotype that guides a distinct treatment pathway.
Clinical scenario: Patients meet high-risk criteria when FEV1 falls below 50%, dyspnoea reaches mMRC grade 2 or above, or they have had two or more exacerbations — or at least one exacerbation requiring hospitalisation — in the preceding year. Within this high-risk group, a non-eosinophilic phenotype is identified by blood eosinophil counts below 300 cells/µL, a finding that differentiates the therapeutic approach from that used in eosinophilic patients.
Treatment approach (partial): For this phenotype, a combined triple inhaled regimen delivered in a single inhaler forms the basis of management. The full combination, any additional considerations, and the complete clinical algorithm are available in the structured protocol.
References
DOI: 10.3390/jcm13020303
If any of these requirements are exceeded, they will be classified as "high risk".
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).
High-risk patients on dual bronchodilation may need triple therapy (LABA + LAMA + CI) in a single inhaler (Figure 1).
If IC is necessary, it is recommended to combine it with LABA + LAMA rather than with LABA alone.
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