{
  "abstract": "Background Acute exacerbations profoundly influence asthma prognosis, yet large-scale data linking baseline blood eosinophil counts to both short-term and long-term exacerbation risk remain limited. We therefore examined this association in one of the largest nationwide cohorts.Methods Using Taiwan’s asthma pay-for-performance database linked to nationwide claims, we conducted a retrospective cohort study of adults with asthma (2015–2020). Baseline peak eosinophil counts defined two groups: high (≥300 cells/µL) and low (<300 cells/µL). Propensity-score matching (1:1) yielded two balanced subcohorts. Multivariable Cox models estimated adjusted HRs (aHRs) for moderate (outpatient, steroid-treated) and severe (Emergency Department visit or hospitalisation) exacerbations within 1 year and over the entire follow-up, controlling for age, sex, Charlson comorbidity score and propensity score.Results Among 407 725 and 961 268 asthma patients in the high and low eosinophil groups, respectively, matched subgroups of 50 360 patients each were analysed. The high eosinophil group had higher rates of severe acute exacerbations (SAEs) within 1 year (14.67 vs 10.950 per 100 person-years) with an adjusted HR of 1.392. Similar trends were observed for moderate acute exacerbations (AEs) (HR 1.548) and all AEs (HR 1.373) within 1 year. These associations persisted after adjustment for age, gender, Charlson comorbidity score and propensity score.Conclusions In this first nationwide, propensity-matched cohort exceeding 100 000 adults, elevated blood eosinophil counts independently predicted both short-term and long-term moderate-to-severe asthma exacerbations across all age and sex strata. Peak eosinophil measurement thus offers a practical biomarker for early identification of high-risk patients who may benefit from intensified anti-eosinophilic or inhaled corticosteroid/long-acting beta agonist-based strategies.",
  "authors": [
    {
      "affiliations": [
        "Mackay Memorial Hospital Taitung Branch, Taitung, Taiwan",
        "Mackay Medical College, New Taipei City, Taiwan"
      ],
      "name": "Chao-Hsien Chen"
    },
    {
      "affiliations": [
        "Medical Research Center, Cardinal Tien Hospital, and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan"
      ],
      "name": "Ya-Hui Wang"
    },
    {
      "affiliations": [
        "Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan",
        "National Sun Yat-sen University, Kaohsiung, Taiwan"
      ],
      "name": "Chih-Cheng Lai"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Cardinal Tien Hospital, and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan"
      ],
      "name": "Cheng-Yi Wang"
    },
    {
      "affiliations": [
        "Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan",
        "Department of Internal Medicine, National Taiwan University, Taipei, Taiwan"
      ],
      "name": "Hao-Chien Wang"
    }
  ],
  "title": "The impact of the eosinophil on the risk of acute exacerbation in asthma patients",
  "uid": "8fe8901f-93e8-5de8-b496-2fc81fe340c2"
}