{
  "abstract": "Background Blood eosinophils (EOS) and fractional exhaled nitric oxide (FeNO) are potential biomarkers for disease progression and treatment response in asthma and chronic obstructive pulmonary disease (COPD). We investigated their association with exacerbations in asthma, COPD and asthma+COPD.Methods NOVEL observational longiTudinal studY is a multicountry prospective study of patients with physician-assigned asthma, COPD and asthma+COPD. Negative binomial and logistic regression analyses were performed for baseline EOS/FeNO (separately and combined), by diagnosis, and for different exacerbation subtypes (all, antibiotics-only, oral corticosteroids (OCS)-only).Results Higher baseline EOS was significantly associated with increased risk of all exacerbations in asthma (incidence rate ratio (IRR) 1.09, 95% CI 1.01 to 1.18, p=0.033), with a trend increase with COPD (IRR 1.09, 95% CI 1.00 to 1.19, p=0.069) but not asthma+COPD. Higher baseline FeNO was significantly associated with decreased risk of all exacerbations in COPD (IRR 0.91, 95% CI 0.84 to 0.99, p=0.025) and increased risk of OCS-only exacerbations in asthma (OR 1.16, 95% CI 1.04 to 1.29, p=0.006) and asthma+COPD (OR 1.55, 95% CI 1.22 to 1.97, p<0.001). In exacerbation risk in asthma (IRR 1.14, 95% CI 1.05 to 1.24, p=0.003), while in COPD, both higher EOS (IRR 1.12, 95% CI 1.02 to 1.24, p=0.033) and lower FeNO (IRR 0.87, 95% CI 0.78 to 0.96, p=0.009) were independently associated with exacerbation risk.Conclusions Higher EOS predicted exacerbations in asthma and COPD, while FeNO showed heterogeneous associations, particularly for OCS-only treated exacerbations. Assessment of exacerbation subtype might improve personalised management. Interpretation is limited by physician-assigned diagnoses, potential ICS confounding and recall bias.",
  "authors": [
    {
      "affiliations": [
        "Department of Pulmonology, University Medical Centre Groningen, Groningen, Netherlands",
        "University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, Netherlands"
      ],
      "name": "Susan Muiser"
    },
    {
      "affiliations": [
        "Respiratory & Immunology, Medical and Payer Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK"
      ],
      "name": "Hana Müllerová"
    },
    {
      "affiliations": [
        "BioPharmaceuticals Medical, AstraZeneca, Cambridge, England, UK"
      ],
      "name": "Laura Belton"
    },
    {
      "affiliations": [
        "BioPharmaceuticals Medical, AstraZeneca, Cambridge, England, UK"
      ],
      "name": "Nifasha Rusibamayila"
    },
    {
      "affiliations": [
        "BioPharmaceuticals Medical, AstraZeneca, Cambridge, England, UK"
      ],
      "name": "Clement Erhard"
    },
    {
      "affiliations": [
        "Respiratory Institute, Clinic Barcelona, FCRB-IDIBAPS, CIBERES, Catedra Salud Respiratoria, University of Barcelona, Barcelona, Spain"
      ],
      "name": "Alvar Agusti"
    },
    {
      "affiliations": [
        "Respiratory Institute, Clinic Barcelona, FCRB-IDIBAPS, CIBERES, Catedra Salud Respiratoria, University of Barcelona, Barcelona, Spain"
      ],
      "name": "Rosa Faner"
    },
    {
      "affiliations": [
        "Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK"
      ],
      "name": "Ian Pavord"
    },
    {
      "affiliations": [
        "Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada"
      ],
      "name": "Simon Couillard"
    },
    {
      "affiliations": [
        "Graduate School of Medical and Dental Sciences, Department of Pulmonary Medicine, Kagoshima University, Kagoshima, Japan"
      ],
      "name": "Hiromasa Inoue"
    },
    {
      "affiliations": [
        "Observational and Pragmatic Research Institute, Singapore",
        "Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK"
      ],
      "name": "David B Price"
    },
    {
      "affiliations": [
        "Servicio de Alergología, Hospital Universitario de Navarra, Pamplona, Spain"
      ],
      "name": "Jose Maria Olaguibel"
    },
    {
      "affiliations": [
        "Department of Pulmonology, University Medical Centre Groningen, Groningen, Netherlands"
      ],
      "name": "Huib A M Kerstjens"
    },
    {
      "affiliations": [
        "Department of Pulmonology, University Medical Centre Groningen, Groningen, Netherlands"
      ],
      "name": "Maarten van den Berge"
    },
    {
      "affiliations": [
        "Department of Pulmonology, University Medical Centre Groningen, Groningen, Netherlands",
        "University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, Netherlands",
        "Respiratory & Immunology, Medical and Payer Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK",
        "BioPharmaceuticals Medical, AstraZeneca, Cambridge, England, UK",
        "Respiratory Institute, Clinic Barcelona, FCRB-IDIBAPS, CIBERES, Catedra Salud Respiratoria, University of Barcelona, Barcelona, Spain",
        "Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK",
        "Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada",
        "Graduate School of Medical and Dental Sciences, Department of Pulmonary Medicine, Kagoshima University, Kagoshima, Japan",
        "Observational and Pragmatic Research Institute, Singapore",
        "Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK",
        "Servicio de Alergología, Hospital Universitario de Navarra, Pamplona, Spain"
      ],
      "name": "The NOVELTY Scientific Community"
    },
    {
      "affiliations": [],
      "name": "The NOVELTY study investigators"
    }
  ],
  "title": "Association of blood eosinophils and exhaled nitric oxide with exacerbations in patients with asthma, COPD and asthma+COPD: the NOVELTY study",
  "uid": "7ada480f-8107-5383-af65-9fa373df5f2e"
}