Blood Eosinophils: A Biomarker of Response to Extrafine Beclomethasone/Formoterol in Chronic Obstructive Pulmonary Disease.

Rationale. Blood eosinophilia has been shown to be associated with a significant proportion of COPD exacerbations and stratifies the clinical response to systemic corticosteroids. The FORWARD study was a randomised, double-blind, parallel group trial that compared 48 weeks treatment with extrafine beclomethasone dipropionate plus formoterol fumarate (BDP/FF) vs. FF, in severe COPD patients with a history of exacerbations. Objectives. We hypothesised that there would be treatment differences in response to BDP/FF when stratifying by baseline blood eosinophil count in a post hoc analysis. Methods. The patients (N=1,184) were stratified into four quartile groups based on the baseline eosinophil count and analyses on exacerbation rate, change in pre dose FEV1 and St. George’s Respiratory Questionnaire [SGRQ] total score over 48 weeks were performed across these. A predictive model of future exacerbations was developed based upon baseline blood eosinophil count and other factors. Results. The adjusted treatment difference over 48 weeks between the BDP/FF and FF groups was largest within the highest baseline blood eosinophil quartile (≥279.8/µl /µl). Within this quartile a significant (i) 46% reduction in exacerbation rate, (ii) 0.102 L improvement in pre bronchodilator FEV1 and (iii) 5.9 units improvement in SGRQ total score were seen in favour of BDP/FF. Predictive modelling suggested that the risk of exacerbations was influenced by baseline blood eosinophils in patients treated with FF alone, but not in patients treated with BDP/FF. Conclusions. The presence of a significant blood eosinophilia seems to be associated with a particularly favorable response to ICS/LABA therapy in COPD patients

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle.

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA-disseminated and implemented in over 70 countries globally-is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease