Are blood eosinophils a prime-time biomarker for COPD management decisions?

Ioanna Tsiligianni,1 Alan G Kaplan2 1Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece; 2Family Physician Airways Group of Canada, University of Toronto, Toronto, ON, Canada COPD is a preventable and treatable disease with patients showing a great disease heterogeneity with respect to risk of exacerbations, symptomatology and health status. Dual bronchodilation has been suggested by the recent Global Initiative for Obstructive Lung Disease guideline as the cornerstone of treatment for COPD, limiting the value of inhaled corticosteroids (ICS) only for patients exacerbating on dual bronchodilators or possibly in those with frequent exacerbations.1 Elevated blood eosinophil count has been suggested as a useful biomarker to guide treatment decisions as its finding is considered consistent with a good ICS response to treatment,2–4 although this has been questioned in a recent post hoc analysis of the FLAME study.5 The practicing physician wants a biomarker to assess the risk of exacerbations and guide treatment accordingly; are blood eosinophils the answer?&nbsp