COPD in Germany: Use of Diagnostic Measures Including Blood Eosinophil Counts in Daily Practice

Abstract

Background Accumulating evidence on the role of blood eosinophils as a biomarker prompted the Global Initiative for Chronic Obstructive Lung Disease (GOLD) committee to refine the existing treatment algorithm by incorporating eosinophil counts into treatment recommendations. However, there is a lack of data on when, why and how frequently such blood tests and other measures are being performed by German private respiratory specialists.

Methods A questionnaire evaluating doctors’ opinions on the use of diagnostic measures at initial diagnosis and during follow-up, including blood eosinophil count in patients with COPD, was completed by 27 respiratory specialists. Medical records from the past 12 months of 251 patients treated by the same physicians were reviewed retrospectively to investigate the use of these measures.

Results Body plethysmography (100 % of doctors) and chest X-ray (96.3 %) were the most commonly used measures according to the doctor’s questionnaire; other measures were COPD assessment test (CAT; 85.2 %) and blood eosinophil count (81.5 %). The evaluation of patients’ medical records revealed that body plethysmography was performed in 72.7 %, the CAT in 61.8 % and chest X-ray in 40.6 % of patients. Blood eosinophil count was measured in 7.2 %.

Conclusions In line with the GOLD recommendations, these results confirm that lung function, imaging and patient-reported outcome questionnaires play a crucial role in managing COPD. Our analyses reveal that measurement of the blood eosinophil count gained importance due to physicians’ increased awareness of these cells as a useful biomarker. However, this test seems to be performed mainly for initial diagnosis and not on a regular basis.

Zusammenfassung

Einleitung Die zunehmende Evidenz zur Rolle der Eosinophilen im Blut als Biomarker veranlasste das Global Initiative for Chronic Obstructive Lung Disease (GOLD)-Komitee, den bestehenden Behandlungsalgorithmus zu verfeinern, indem die Bestimmung der Eosinophilenzahl in die Behandlungsempfehlungen aufgenommen wurde. Es fehlen jedoch Daten darüber, wann, warum und wie häufig solche Blutuntersuchungen und auch andere diagnostische Maßnahmen von pneumologischen Fachärzten in Deutschland durchgeführt werden.

Methoden Anhand eines Arztfragebogens wurde die fachärztliche Einschätzung von 27 Pneumologen zum Einsatz von diagnostischen Maßnahmen, einschließlich der Zahl der Eosinophilen, bei der Erstdiagnose und während des Verlaufs der COPD-Erkrankung evaluiert. Die medizinischen Aufzeichnungen von 251 Patienten dieser Ärzte wurden in einer 12-monatigen, retrospektiven Analyse ausgewertet, um die tatsächliche Anwendung dieser Maßnahmen zu untersuchen.

Ergebnisse Bodyplethysmografie (100 % der Ärzte) und Röntgen des Thorax (96,3 %) waren laut Arztfragebogen die Tests, die am häufigsten verwendet wurden. Weitere Maßnahmen waren der COPD Assessment-Test (CAT; 85,2 %) und die Messung der Zahl der Blut-Eosinophilen (81,5 %). Die retrospektive Auswertung der Patientenakten ergab, dass bei 72,7 % der Patienten eine Bodyplethysmografie, bei 61,8 % der CAT und bei 40,6 % eine Röntgenaufnahme des Thorax durchgeführt wurde. Die Eosinophilenzahl im Blut wurde in 7,2 % gemessen.

Schlussfolgerungen In Übereinstimmung mit den GOLD-Empfehlungen bestätigen diese Ergebnisse, dass Lungenfunktion, Bildgebung und der Einsatz von Fragebögen zur Abbildung der Lebensqualität eine entscheidende Rolle bei der Behandlung von COPD spielen. Unsere Analysen zeigen, dass die Messung der Eosinophilenzahl im Blut aufgrund des zunehmenden Bewusstseins der Ärzte für diese Zellen als nützliche Biomarker an Bedeutung gewonnen hat. Dieser Test scheint jedoch hauptsächlich zur Erstdiagnose und nicht während des Verlaufs der Erkrankung durchgeführt zu werden.

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