Can a blood test reduce prednisolone use?
People with COPD are often given prednisolone during a severe exacerbation. It helps some people but can also cause unpleasant side effects. With support from Longfonds, Dr Pieter-Paul Hekking is investigating who may not benefit from it. “This will help us develop more personalised treatment with fewer unnecessary medicines and side effects.”
Prednisolone: widely used, but not without risks
Around 33,000 people with COPD are admitted to hospital each year because of a severe exacerbation. Almost everyone receives the same treatment: antibiotics where needed, nebulised medication, sometimes oxygen, and a short course of prednisolone. “Yet around 70% may not benefit from prednisolone,” says respiratory physician and researcher Pieter-Paul Hekking of Franciscus Gasthuis & Vlietland in Rotterdam. “It may even cause harm.” Prednisolone is powerful, but it can also cause unpleasant side effects. In the short term, these include disrupted blood sugar levels, insomnia and mood changes. Long-term risks include osteoporosis, heart problems and an increased risk of death. Many people would therefore prefer not to take it.
“About 70% of people with a severe COPD exacerbation do not benefit from prednisolone.”
Personalised care
The study is investigating whether prednisolone can safely be withheld from people with low levels of eosinophils in their blood. Eosinophils are white blood cells involved in the immune response. “People with high eosinophil levels usually respond well to prednisolone,” Hekking explains. “But when levels are low—which is the case for around 70% of patients—it is unclear whether the medicine helps. A simple blood test can show this immediately.” If the study finds that prednisolone can safely be withheld in these cases, it would be a major step towards personalised care: fewer unnecessary medicines, fewer side effects and more targeted treatment.
The study
“We take blood samples from people who arrive at the hospital’s emergency department with a COPD exacerbation,” says Hekking. “Those with low eosinophil levels are invited to take part in the study. We aim to recruit 850 participants.” Half of the participants receive prednisolone in addition to standard treatment. The doctor decides whether antibiotics, oxygen and nebulised medication are also needed. The other half receive a placebo—a pill with no active ingredient—alongside the same standard care. Neither the patient nor the treatment team knows which group the patient is in. “This is called a double-blind study,” Hekking explains. “It allows us to assess fairly what the medicine actually does.” The researchers compare the results during the first 30 days. “It is possible that more people in the placebo group will need more intensive treatment or admission to intensive care, but we do not expect that. We hope to prove that people with low eosinophil levels can safely be treated without prednisolone.”
Why this matters
“If our theory is correct, the treatment guidelines will need to change,” says Hekking. “Hospitals would then give prednisolone only to patients with high eosinophil levels.” The aim is clear: to make care more personalised and effective. “We only want to use prednisolone when it is truly necessary. This will help prevent unnecessary side effects and complications in people experiencing a COPD exacerbation.” It could also mean fewer hospital admissions caused by side effects and lower healthcare costs. In other words: better health, less pressure on healthcare services and lower costs.