New biomarkers for COPD could help doctors monitor and treat the disease

Vienna, Austria – Two studies presented during the 2024 congress of the European Respiratory Society (ERS) showed on the one hand that CT scanning could help to better guide the treatments of patients with COPD and on the other hand that the analysis of volatile organic compounds in patients’ breath would make it possible to better predict exacerbations.

Federico Baraldiresearcher in respiratory medicine at the University of Ferrara (Ferrara, Italy), and currently a research fellow at Imperial College London (UK), told Medscape Medical News that CT scans are underutilized to assess airway thickening and inflammation, which are essential for identifying patients who may benefit from biologic treatments.

“Eosinophil counts are not always accompanied by imaging studies like CT scans to give a complete picture of the disease,” he said.

In other research presented at ERS 2024, scientists identified biomarkers of COPD exacerbation in patients’ breath to predict and prevent episodes.

“There is no effective tool to predict COPD exacerbations before they occur,” said Jorrit van Poelgeestdoctoral candidate at UMC Amsterdam (Netherlands), Medscape Medical News. This leads to reactive treatment rather than proactive management. His group is developing a tool that allows patients to monitor compounds in their breath and act quickly if exacerbations are imminent.

Eosinophilia and airway thickness

The researchers recruited 100 participants to the London COPD Exacerbation Cohort. They measured blood eosinophil counts (BECs) annually for 4 years during stable periods and collected data on exacerbations before treatment with oral corticosteroids. They classified the patients according to their eosinophil status:

• Persistent eosinophilic group: BEC > 300 at least three visits but not

• Intermittent eosinophilic group: BEC > 300 during at least one visit but

• Never eosinophilic group: BEC

All participants underwent quantitative CT scanning, which was analyzed to determine the relationship between lumen and airway wall thickness (Pi10), emphysema, air trapping, and opacity. in frosted glass.

The results, presented at the ERS 2024 congress, showed that the Pi10 index was significantly higher in the persistent eosinophilic group than in the never eosinophilic and intermittent eosinophilic groups. The researchers found no differences between these groups when it came to air trapping, emphysema, or ground glass opacity. There was no significant difference in Pi10 between eosinophilic exacerbators and non-eosinophilic exacerbators.

These findings suggest that persistent eosinophilia in COPD is associated with increased airway wall thickness, Dr. Baraldi said. This could have important clinical implications, as it raises the question of whether targeting airway eosinophilic inflammation could alter airway thickness in COPD patients.

“We are entering the era of biological treatments, and without CT scanning we risk missing a lot of valuable information,” said Dr. Baraldi.

According to him, inhaled corticosteroids do not have a significant impact on airway thickening (Pi10), indicating the need for more targeted treatments, such as biologics.

“Biological therapies like dupilumab will soon be available for COPD patients, hence the importance of having biomarkers like Pi10 to monitor the effect of treatment. »

Volatile Biomarkers for COPD Exacerbation

In another study presented at the ERS 2024 conference, researchers identified volatile organic compounds (VOCs) associated with COPD exacerbations as potential biomarkers for early detection and monitoring.

The researchers conducted a systematic literature search across multiple databases to identify relevant VOCs. They then validated these VOCs using data from the trial TEXACOLDwhich included longitudinal samples from 14 COPD patients at three different time points: at the start of the study, during an exacerbation, and during follow-up.

The search found 12 candidate VOCs. These were analyzed by gas chromatography and mass spectrometry on 42 samples from participants in the TEXACOLD trial.

The data were then processed using partial least squares discriminant analysis (sPLSDA) and a Wilcoxon test.

The resulting sPLSDA model shows that the VOC profile changes significantly when a patient experiences an exacerbation, suggesting that the identified VOCs could serve as biomarkers to detect the onset of an exacerbation.

The VOC profile changes again when the patient recovers from the exacerbation. This could be useful for monitoring healing and determining when a patient has returned to baseline.

The VOC profile returns to a state similar to the pre-exacerbation baseline after recovery. This result is important because it indicates that changes in VOCs during an exacerbation are temporary and reversible.

These results suggest that the identified VOCs could be biomarkers to detect COPD exacerbations.

Currently, these analyzes are performed using gas chromatography, but researchers are developing an at-home device that can analyze patients’ breath and provide results in real time.

This article was translated from Medscape.com using multiple editorial tools, including AI, in the process. The content was reviewed by the editorial staff before publication.