PP19 ICS-CONTAINING THERAPY, BLOOD EOSINOPHILS LEVEL AND ITS IMPACT ON EXACERBATION IN COPD PATIENTS: EXACOS-MY STUDY

Aisya Natasya Musa1,2, Ahmad Izuanuddin Ismail1,2, Syazatul Syakirin Sirol Aflah3, Chee Kuan Wong4
1 Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
2 Hospital Al-Sultan Abdullah Universiti Teknologi MARA (UiTM), Kampus Puncak Alam, Puncak Alam, Malaysia
3 Institut Perubatan Respiratori, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
4 Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

Introduction:

The role of inhaled corticosteroids (ICS) in COPD treatment remains debatable. Benefit was seen in patients with high eosinophil counts and exacerbators. However, there is limited study in Malaysia on the impact of ICS on exacerbation rates and its relationship with blood eosinophil levels.

Objective:

To explore the impact of ICS-containing therapy on exacerbation rates in relation with blood eosinophils levels in COPD patients.

Methods:

The EXACerbations and their OutcomeS among COPD patients in MalaYsia (EXACOS-MY) study was an observational multi-centre (3 tertiary hospitals) cross-sectional study in Malaysia (2018 to 2022). Patients with confirmed diagnosis of COPD and with history of at least one severe exacerbation were included. Data on ICS prescription, blood eosinophils level and exacerbation history were analysed.

Results:

A total of 471 patients were included, mostly male (94.3%), GOLD D (69.6%) with a mean age of 72.38±9.11years. Overall exacerbation rate was 1.06 per patient per year. At baseline, 46% received ICS-containing therapy (r-ICS). Throughout the 3 years observation, a total of 65.4% were in the r-ICS group. The r-ICS group had longer intervals between severe exacerbation compared to those who are not on ICS-containing therapy (n-ICS) (9.7% vs. 2.5% had intervals of > 6-12 months, and 3.6% vs. 0.6% had intervals of > 1 year, respectively; p = 0.002). No patients in the r-ICS group had exacerbation within a month. There was a trend of fewer exacerbations within 12 months with increasing blood eosinophil count in the r-ICS group (p = 0.08). In contrast, all patients in the n-ICS group had exacerbation within 12 months, regardless of eosinophil count.

Conclusion:

ICS use was associated with less frequent exacerbation and longer intervals between exacerbation episodes, with greater benefits observed in patients with higher blood eosinophil counts. These findings suggest the protective role of ICS in COPD management.