Actionable Biomarkers in Acute Exacerbations of COPD: Corticosteroid and Antibiotic Stewardship.

Authors

Yang Li, Yang Li

Published in

International journal of chronic obstructive pulmonary disease. Volume 21. Pages 649646. Epub Oct 28, 2026.

Abstract

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) arise from heterogeneous inflammatory and infectious processes, yet systemic corticosteroids and antibiotics are often prescribed empirically. This narrative review evaluates biomarkers according to the acute treatment decisions they can support, drawing on randomized trials and supporting clinical studies evaluated through August 9, 2026. Blood eosinophils have the most developed evidence for corticosteroid guidance: trials support treatment selection or withholding in primary care and serial treatment shortening after an initial dose in hospitalized patients. C-reactive protein supports antibiotic stewardship most clearly in primary care, with more limited inpatient evidence. Procalcitonin can reduce antibiotic use in selected non-intensive-care inpatients, whereas the intensive-care trial failed to establish non-inferiority for mortality and did not reduce antibiotic exposure. These findings depend on the tested population, sampling time, threshold, and treatment rule. Rapid molecular pathogen tests improve diagnostic yield and turnaround time; their integration into COPD-specific treatment algorithms remains a research priority. Multimarker strategies and acute biologic treatment offer further avenues for investigation, with acute biologic evidence currently derived from a mixed asthma/COPD population. Organizing evidence around a biomarker-decision-population framework separates established stewardship applications from emerging treatment strategies. Clinical utility ultimately depends on whether the complete strategy preserves or improves patient outcomes and can be delivered reliably in routine care.

PMID:
42968937
Bibliographic data and abstract were imported from PubMed on 02 Nov 2026.

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