Introduction: Inflammation is an integral component of bronchial asthma associated with hyperresponsiveness and chest tightness. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been proven as independent inflammatory markers in various conditions. This study is an effort to evaluate the correlation between these two markers in asthma. Materials and Method: With the approval of the Ethical Committee, Osmania Medical College, Hyderabad, 194 subjects were enrolled for the current study. Out of which, 122 were proven asthmatics diagnosed by pulmonologist and 72 non-asthmatic healthy volunteers. Blood samples were collected from all the individuals and subjected to complete blood count. NLR and PLR were calculated and analysed for each study group. The continuous data were expressed as mean ± standard deviation and Student's t-test. The correlation analysis was performed between the various groups. Results: A statistically significant difference was noted with respect to NLR and PLR between asthma patients and non-asthmatic healthy controls (P = 0.0001). NLR alone varied significantly between responders (mild asthmatics) and poor responders (moderate asthmatics) of the patient group. Further, a positive correlation was noted between NLR and PLR in all the categories, with the highest value in the poor responders. The results are indicative of strong interdependency of NLR and PLR in a condition with higher inflammation. Conclusion: Future studies are warranted to explore this relation in understanding the disease severity/drug response to monitor or to identify the better drug target.

Background: Asthma is a chronic obstructive airway disease, associated with an altered leukocyte population in the airways as well as in blood circulation with dysregulated immune responses. Limited studies are available that suggest the role of neutrophils and their derived markers in asthma severity, however, no reports exist on the combined effect. Methods: To examine these markers' individual and combined influence, we recruited a total of 92 individuals, 60 asthmatics (30 mild and 30 moderate) and 32 nonasthmatic healthy controls from South India. Absolute neutrophil count (ANC) and neutrophil-to-lymphocyte ratio (NLR) were obtained from the complete blood count, and serum neutrophil elastase (sNE) was estimated through ELISA. Results: A significant variation in the means of ANC, NLR, and sNE was observed between asthma patients and healthy controls, whereas mild and moderate asthmatics demonstrated the difference in only neutrophil derivates (NLR and sNE). The receiver operating characteristic curve analysis revealed NLR as an excellent diagnostic marker (area under the curve [AUC] = 0.79, cutoff = 1.51, Sn = 95, Sp = 65.53, P = 0.0001), whereas sNE has an excellent diagnostic and prognostic capacity (AUC = 0.92, cutoff = 14.27, Sn = 81.67, Sp = 90.63, P = 0.0001 and AUC = 0.86, cutoff = 18.82, Sen = 80, Spe = 83.33, P = 0.0001). No correlation was noted between NLR and sNE, signifying their independent control on asthma severity. The additive influence of NLR and sNE was noted when analyzed together in a Combination of NLR and sNE (CNN). CNN-1 score exhibited a 5-fold and CNN-2 19-fold increased risk of asthma severity. Conclusion: Based on the present findings, it appears that CNN may emerge as a single predictive marker in asthma prognosis. This is the first study of its kind projecting the potentiality of CNN that needs to be tested in a large cohort as the limitation of the current study is the sample size.

Bronchial asthma is a complex respiratory disorder, exhibits several endotypes and phenotypes due to different underlying cellular and molecular mechanisms. Globally it affects 300 million individuals, with the prevalence of 2–3% in India, contributing to morbidity and mortality. Over 50 cytokines have been identified in asthma. The dysregulation in Th1 and Th2 cytokines is implicated in the patho-mechanism of pulmonary inflammation and airway remodeling. The aim of the current study was to access the circulating levels of IL-1β (pro-inflammatory) and IL-10 (anti-inflammatory) cytokines using sandwich enzyme-linked immunosorbent assay (ELISA). In this case-control study we recruited a total of 164 subjects (104 adult onset asthma patients and 60 non-asthmatic healthy controls) from south India. Data exhibited increased levels of IL-1β and decreased levels of IL-10 in asthma patients compared to the healthy controls. Subgroup analysis revealed significant elevation in the circulating levels of IL-1β and Th1:Th2 (IL-1β/IL-10) ratio in patients with uncontrolled and long-standing disease (>10 years). Receiver operating curve analysis of individual cytokines and ratios showed good and excellent discriminating capacity respectively for health vs disease and controlled vs uncontrolled. However, IL-1β showed better incisive capacity for disease duration. Based on our observation it appears that rather than individual cytokine(s), the balance between pro and anti-inflammatory cytokines are crucial in the patho-mechanism of asthma. However, developing a signature profile of multiple cytokines using cut-off values may prove to be more promising for diagnostic, prognostic and therapeutic purposes of bronchial asthma.

Homoeostasis of the immune system is regulated by cell-mediated immune-inflammatory responses. The shift of the immune response is clearly reflected by the cellular ratios than individual cell count. Neutrophil-to-lymphocyte ratio (NLR) serves as a good cell-based marker of inflammation, which is being investigated in various inflammation-related diseases. Asthma which is a chronic inflammatory airway disease associated with hyperresponsiveness, recurrent attacks, wheezing, coughing and chest tightness coupled with multicellular influx of granulocytes with mild-to-severe symptoms of and altered NLR. The aim of the present study was to explore the existing literature on NLR in asthma to realise its clinical utility in asthma and its severity. We searched online database resources 'PubMed' and 'Google Scholar' up till now (20th May, 2022), and studies were included as per eligibility criteria. The data collected were reviewed and analysed. The study included eight published articles on NLR and asthma. The analysis revealed that there is a significant difference in mean NLR between healthy controls and asthma patients (1.57 ± 0.35 vs. 2.36 ± 0.30; P < 0.0001); further, severe versus non-severe asthma cases showed the highest mean NLR as compared to non-severe cases (4.82 ± 2.85 vs. 2.13 ± 0.17; P < 0.0001). Receiver operating curve analysis of NLR showed excellent discriminating capacity, for health versus disease and controlled versus uncontrolled. This mini review suggests NLR can serve as a non-expensive, non-invasive monitoring tool to reduce the risk of exacerbation and hospitalisation. However, large studies are warranted.