Comparison of treatment strategies for eosinophilic COPD and eosinophilic bronchitis.
| Feature | Eosinophilic COPD | Eosinophilic bronchitis |
|---|---|---|
| Primary goal of treatment | Reduce exacerbation frequency, improve airflow, control inflammation | Suppress eosinophilic airway inflammation and resolve chronic cough |
| Role of ICS | Indicated in patients with blood eosinophil count ≥ 300 cells/μL or frequent exacerbations | First-line therapy due to corticosteroid responsiveness |
| Bronchodilators (LABA/LAMA) | Commonly used in combination with ICS for symptom control and airflow limitation | Not typically indicated, as airflow obstruction is absent |
| Systemic corticosteroids | Reserved for acute exacerbations | Occasionally used for short-term control if symptoms persist despite ICS |
| Biologic therapy | May be considered in select patients with high eosinophil counts and frequent exacerbations | Not routinely used; insufficient evidence for benefit |
| Antibiotics | Used during bacterial exacerbations | Not part of routine management |
| Methacholine challenge test | May help exclude the asthma component | Used to confirm the absence of airway hyperresponsiveness |
| Monitoring strategy | Regular lung function tests, symptom tracking, and exacerbation history | Monitor cough resolution and eosinophil counts in sputum |
| Treatment response time | Gradual, varies with baseline lung function and eosinophil burden | Typically rapid (within weeks) with corticosteroid therapy |
COPD: chronic obstructive pulmonary disease; ICS: inhaled corticosteroids.
MDG, GWC: Conceptualization, Supervision, Writing—review & editing. GMW, LD, VP: Conceptualization, Writing—original draft (wrote section Pathophysiology of eosinophils (correspondence to Garry Michael Walsh: g.m.walsh@abdn.ac.uk)). GP, AMP, CDV, PT, DK, F Buta, NL, JO, MMA, CSR: Conceptualization, Writing—original draft (wrote section Eosinophilic inflammation across the upper airways: mechanisms, biomarkers, and therapeutic advances (correspondence to Giovanni Paoletti: giovanni.paoletti@hunimed.eu)). AY, F Braido, NR, DB: Conceptualization, Writing—original draft (wrote section Eosinophils and asthma (correspondence to Arzu Yorgancıoğlu: arzuyo@hotmail.com)). MC, MM: Conceptualization, Writing—original draft (wrote section Eosinophilic COPD (correspondence to Mario Cazzola: mario.cazzola@uniroma2.it)). GG: Conceptualization, Writing—original draft (wrote section Eosinophilic granulomatosis with polyangiitis and allergic bronchopulmonary aspergillosis (correspondence to Giuseppe Guida: giuseppe.guida@gmail.com) and Hypereosinophilic syndromes (correspondence to Giuseppe Guida: giuseppe.guida@gmail.com)). FP, RGC: Conceptualization, Writing—original draft (wrote section Other eosinophilic lung diseases (correspondence to Francesco Puppo: puppof@unige.it)). GM: Conceptualization, Writing—original draft (wrote section Eosinophilic myocarditis (correspondence to Giuseppe Murdaca: giuseppe.murdaca@unige.it)). PC, GCP: Conceptualization, Writing—original draft (wrote section Psychological and psychopathological components of eosinophilic myocarditis and pneumonia, a disease (correspondence to Pasquale Caponnetto: pasquale.caponnetto@unict.it)). WvdV, ER, NRF: Conceptualization, Writing—original draft (wrote section Eosinophils in gastrointestinal diseases (correspondence to Willem van de Veen: willem.vandeveen@siaf.uzh.ch)). TZ FRW: Conceptualization, Writing—original draft (wrote section Eosinophils and urticaria (correspondence to Torsten Zuberbier: torsten.zuberbier@charite.de)). MR, ERG: Conceptualization, Writing—original draft (wrote section Eosinophils in anaphylaxis and DRESS (correspondence to Matija Rijavec: Matija.Rijavec@klinika-golnik.si)). All authors read and approved the submitted version.
Giorgio Walter Canonica is the Editor-in-Chief of Exploration of Asthma & Allergy; Mario Di Gioacchino is the Co Editor-in-Chief of Exploration of Asthma & Allergy; Diego Bagnasco, Pasquale Caponnetto, Willem Van de Veen, Linhong Deng, Nelson Rosario Filho, Eva Rebelo Gomes, Giuseppe Murdaca, Vincenzo Patella, Ana Margarida Pereira, Francesco Puppo, Erminia Ridolo, Matija Rijavec, Nikoletta Rovina, Franziska Roth-Walter, Pongsakorn Tantilipikorn, Arzu Yorgancıoğlu are Editorial Board Members of Exploration of Asthma & Allergy; Fulvio Braido, Mario Cazzola, Giuseppe Guida, Mauro Maniscalco, Mário A. Morais-Almeida, Giovanni Paoletti, Chae-Seo Rhee, Garry M. Walsh, Torsten Zuberbier are Associate Editors of Exploration of Asthma & Allergy. They all had no involvement in the decision-making or the review process of this manuscript. The other authors declare no conflicts of interest.
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All datasets generated for this study are included in the manuscript.
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