Prevalence and Baseline Clinical Characteristics of Eosinophilic Chronic Obstructive Pulmonary Disease: A Meta-Analysis and Systematic Review

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with different clinical and pathophysiological characteristics. Cumulative evidence shows that eosinophil levels may be connected to the therapeutic effects and phenotype of COPD. However, the prevalence of eosinophilic inflammation in COPD and the baseline characteristics of eosinophilic COPD remain unknown. Our study investigated the prevalence of COPD with eosinophil levels of >2% and the characteristics of eosinophilic COPD. Methods: We searched the Cochrane Central Library, Medline, Embase, and the Web of Science for trials of eosinophil and COPD published from database inception to May 1, 2019. Results: In total, 40,112 COPD patients that were involved in 19 trials were included in the final analysis. The prevalence of eosinophilic COPD ranged from 18.84 to 66.88%, with an average prevalence of 54.95% across all studies. We found that men, ex-smokers, individuals with a history of ischemic heart disease, and individuals with a higher body mass index (BMI) were at higher risk of eosinophilic COPD (OR 1.36, 95% CI 1.26-1.46, P < 0.00001; OR 1.23, 1.12-1.34, P < 0.0001; OR 1.31, 1.14-1.50, P = 0.001; MD 0.70, 0.27-1.12, P = 0.001). There was, however, a lower proportion of GOLD stage I patients among those with eosinophilic COPD (OR 0.84, 0.73-0.96, P = 0.01). No significant differences were found in terms of age, current smoker status, pack-years smoked, percent of predicted forced expiratory volume in 1 s, hypertension, diabetes, or other GOLD stages between the two groups (P > 0.05). Conclusions: Our analysis suggests that eosinophilic inflammation is prevalent in COPD. Eosinophilic COPD was more likely to occur in men, ex-smokers, those with a higher BMI, and those with a high risk of some comorbidity; however, a lower proportion of patients with eosinophilic COPD experienced mild airflow limitations.

Keywords: airflow; biomarkers; chronic obstructive pulmonary disease; eosinophil; inflammation; smoking.

Figure 1

Flow diagram. CENTRAL, Cochrane Central Register of Controlled Trials; RCT, randomized controlled trial.

Figure 2

Comparison of gender character between eosinophilic and non-eosinophilic COPD. M.-H., Mantel-Haenszel; CI, confidence interval; Eos, eosinophilic; Non-eos, non-eosinophilic; COPD, chronic obstructive pulmonary disease.

Figure 3

Comparison of age character between eosinophilic and non-eosinophilic COPD. SD, standard derivation; IV, Inverse Variance; CI, confidence interval; Eos, eosinophilic; Non-eos, non-eosinophilic; COPD, chronic obstructive pulmonary disease.

Figure 4

Comparison of BMI character between eosinophilic and non-eosinophilic COPD. SD, standard derivation; IV, Inverse Variance; CI, confidence interval; BMI, body-mass index; Eos, eosinophilic; Non-eos, non-eosinophilic; COPD, chronic obstructive pulmonary disease.