Reynold A. Panettieri, Jr., MD, prepared useful practice aids pertaining to COPD management for this CME activity titled "The Role of the Eosinophil in COPD: Implications for Precision Care and Novel Treatments." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2IqQtR0. CME credit will be available until May 24, 2019.

1. This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
GOLD Guidelines for the Assessment
and Treatment of Patients With COPD1
PRACTICE AID
Access the activity,“The Role of the Eosinophil in COPD: Implications for Precision Care and Novel Treatments,”at
www.peerview.com/UZZ40.
The Redefined ABCD Assessment Tool
Spirometrically
confirmed
diagnosis
Assessment of
airflow
limitation
Assessment of
symptoms/risk
of exacerbations
Post-bronchodilator
FEV1
/FVC <0.7
FEV1
, % predicted
GOLD 1 ≥80
GOLD 2 50-79
GOLD 3 30-49
GOLD 4 <30
≥2 or ≥1 leading to
hospital admissions
0 or 1 (not leading to
hospital admission)
Moderate/Severe
Exacerbation History
C D
A B
mMRC 0-1
CAT <10
mMRC ≥2
CAT ≥10
Symptoms

2. GOLD Guidelines for the Assessment
and Treatment of Patients With COPD1
CAT: COPD Assessment Test; FEV1
: forced expiratory volume in 1 second; FVC: forced vital capacity; GOLD: Global Initiative for Chronic Obstructive Lung Disease; ICS: inhaled corticosteroid; LABA: long-acting beta agonist; LAMA: long-acting muscarinic
antagonist; mMRC: Modified Medical Research Council.
1. http://goldcopd.org/gold-reports/. Accessed April 26, 2018.
PRACTICE AID
Access the activity,“The Role of the Eosinophil in COPD: Implications for Precision Care and Novel Treatments,”at
www.peerview.com/UZZ40.
LABA or LAMA
LAMA + LABA
symptoms
persist
LAMA + LABA LABA + ICS
LAMA
further
exacerbations
Consider
roflumilast or
macrolidea
LABA
+ ICS
LAMA
+ LABA
further
exacerbations
symptoms
persist/further
exacerbation(s)
LAMA
A B
DC
Continue, stop, or
try alternative
class of
bronchodilator
evaluate effect
Bronchodilator
= Preferred treatment
further
exacerbations
LAMA
+ LABA
+ ICS
a
Consider roflumilast if FEV1
<50% predicted, and patient has chronic bronchitis. Consider macrolide in former smokers.
GOLD Treatment Recommendations

3. Access the activity,“The Role of the Eosinophil in COPD: Implications for Precision
Care and Novel Treatments,”at www.peerview.com/UZZ40.
The Role of Eosinophils in
Personalizing the Treatment
of Patients With COPD
This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
DNAzyme: deoxyribozymes; FEV1
: forced expiratory volume in 1 second; GATA3: GATA binding protein 3; ICS: inhaled corticosteroid; IL-5: interleukin-5; LABA: long-acting beta agonist; MENT:
maximum eosinophil number threshold; MOA: mechanism of action; PBE: peripheral blood eosinophil; SGRQ: St. George's Respiratory Questionnaire.
1. Park HY et al. Int J COPD. 2016;11:23-30.
2. Pavord ID et al. Thorax. 2016;71:118-125.
3. Bafadhel M et al. Lancet Respir Med. 2018;6:117-126.
4. Watz H et al. Lancet Respir Med. 2016;4:390-398.
5. Veljanovski J, Ouellette DR. Int J Chron Obstruct Pulmon Dis. 2018:28;13:1061-1069.
6. Pavord ID et al. N Engl J Med. 2017;377:1613-1629.
7. http://www.pharmatimes.com/news/gsk_files_nucala_for_copd_1210779. Accessed April 26, 2018.
8. Brightling CE et al. Lancet Respir Med. 2014;2:891-901.
9. https://www.clinicaltrials.gov/ct2/show/NCT02155660. Accessed April 26, 2018.
10. https://www.clinicaltrials.gov/ct2/show/NCT02138916. Accessed May 16, 2018.
11. Greulich T et al. Respir Res. 2018;19:55.
PRACTICE AID
Studies That Can Inform the Choice to Treat With ICS
Study Key Results
KOLD Study1
• High blood eosinophils (>260 cells/mcL) and high plasma periostin
(>23 ng/mL) were associated with improved lung function after 3 months of
ICS/LABA treatment
Fluticasone/Salmeterol
Study2
• For patients with blood eosinophils ≥2%, fluticasone/salmeterol was associated
with significant reductions in exacerbation rates compared with tiotropium
and placebo
• No significant difference was seen in the subgroup of patients with blood
eosinophils <2%
• No relationship was observed between eosinophil subgroup and treatment
effect on FEV1
and the SGRQ
INCONTROL 13
• The magnitude of protection against risk of exacerbation in patients treated
with budesonide/formoterol compared with formoterol alone increased with
rising blood eosinophil levels
• In current smokers with PBE ≥0.6 x 109
cells/L, budesonide/formoterol
significantly reduced the rate of exacerbation by 68% compared with
formoterol alone; in former smokers, the risk was reduced by 34% to 39%,
regardless of PBE levels
WISDOM4 • Eosinophil counts ≥4% or ≥300 cells/mcL may identify a deleterious effect of
ICS withdrawal
Retrospective Analysis of
Internal Medicine Clinic
to Identify Risk Factors for
Respiratory Hospitalization
for COPD Patients5
• Airflow obstruction not a risk factor for respiratory hospitalizations
• MENT above the threshold of 0.5 K/mcL was the nontreatment factor most
significantly associated with respiratory hospitalization, both in the study
population as a whole and in the cohort without obstruction
Emerging Agents Targeting Eosinophilic Inflammation
Drug MOA Status
Mepolizumab6,7
Anti–IL-5 Under FDA review
Benralizumab8-10
Anti–IL-5 receptor alpha Phase 3 studies recently completed
SB01011
GATA3-specific DNAzyme Positive phase 2 data