Alveolar eosinophilia in current smokers with chronic obstructive pulmonary disease in the SPIROMICS cohort

To the Editor: Novel therapies for chronic obstructive pulmonary disease (COPD) are urgently needed. Eosinophilic inflammation is an appealing target, because blood or sputum eosinophils in stable COPD may predict responses to systemic or inhaled corticosteroid therapy. Titrating steroid therapy in the stable state on the basis of sputum eosinophils reduced severe exacerbations and has been recommended for clinical practice. However, the prevalence of eosinophilic inflammation in COPD and its uniformity between systemic and lung compartments remain incompletely defined. Controversy exists on whether sputum analysis (reflecting large airway events) is required, or whether blood eosinophilia can suffice, on the basis of strong correlation between the 2 found by 1 group. Thus, better understanding of eosinophils in COPD is needed