Using inflammatory index to distinguish asthma, asthma-COPD overlap and COPD: A retrospective observational study

BackgroundAlthough asthma and chronic obstructive pulmonary disease (COPD) are two well-defined and distinct diseases, some patients present combined clinical features of both asthma and COPD, particularly in smokers and the elderly, a condition termed as asthma-COPD overlap (ACO). However, the definition of ACO is yet to be established and clinical guidelines to identify and manage ACO remain controversial. Therefore, in this study, inflammatory biomarkers were established to distinguish asthma, ACO, and COPD, and their relationship with the severity of patients' symptoms and pulmonary function were explored. Materials and methodsA total of 178 patients, diagnosed with asthma (n = 38), ACO (n = 44), and COPD (n = 96) between January 2021 to June 2022, were enrolled in this study. The patients' pulmonary function was examined and routine blood samples were taken for the analysis of inflammatory indexes. Logistic regression analysis was used to establish inflammatory biomarkers for distinguishing asthma, ACO, and COPD; linear regression analysis was used to analyze the relationship between inflammatory indexes and symptom severity and pulmonary function. ResultThe results showed that, compared with ACO, the higher the indexes of platelet, neutrophil-lymphocyte ratio (NLR) and eosinophil-basophil ratio (EBR), the more likely the possibility of asthma and COPD in patients, while the higher the eosinophils, the less likely the possibility of asthma and COPD. Hemoglobin and lymphocyte-monocyte ratio (LMR) were negatively correlated with the severity of patients' symptoms, while platelet-lymphocyte ratio (PLR) was negatively correlated with forced expiratory volume in the 1 s/forced vital capacity (FEV1/FVC) and FEV1 percent predicted (% pred), and EBR was positively correlated with FEV1% pred. ConclusionInflammatory indexes are biomarkers for distinguishing asthma, ACO, and COPD, which are of clinical significance in therapeutic strategies and prognosis evaluation.

Automated summary

This study investigated the role of inflammatory biomarkers in distinguishing asthma, asthma-COPD overlap (ACO), and chronic obstructive pulmonary disease (COPD). The results showed that higher platelet, neutrophil-lymphocyte ratio (NLR), and eosinophil-basophil ratio (EBR) indexes were associated with a higher likelihood of asthma and COPD, while higher eosinophil levels were associated with a lower likelihood. Hemoglobin and lymphocyte-monocyte ratio (LMR) were negatively correlated with symptom severity, platelet-lymphocyte ratio (PLR) was negatively correlated with lung function parameters (FEV1/FVC and FEV1% pred), and EBR was positively correlated with FEV1% pred.