Full blood count parameters for the detection of asthma inflammatory phenotypes

Zhang, X. -Y., Simpson, J. L., Powell, H., Yang, I. A., Upham, J. W., Reynolds, P. N., Hodge, S., James, A. L., Jenkins, C., Peters, M. J., Lin, J. -T. and Gibson, P. G. (2014) Full blood count parameters for the detection of asthma inflammatory phenotypes. Clinical and Experimental Allergy, 44 9: 1137-1145. doi:10.1111/cea.12345

Author Zhang, X. -Y.
Simpson, J. L.
Powell, H.
Yang, I. A.
Upham, J. W.
Reynolds, P. N.
Hodge, S.
James, A. L.
Jenkins, C.
Peters, M. J.
Lin, J. -T.
Gibson, P. G.
Title Full blood count parameters for the detection of asthma inflammatory phenotypes
Journal name Clinical and Experimental Allergy   Check publisher's open access policy
ISSN 1365-2222
Publication date 2014-09
Year available 2014
Sub-type Article (original research)
DOI 10.1111/cea.12345
Open Access Status
Volume 44
Issue 9
Start page 1137
End page 1145
Total pages 9
Place of publication Chichester, West Sussex, United Kingdom
Publisher Wiley-Blackwell Publishing
Collection year 2015
Language eng
Formatted abstract

In asthma, the airway inflammatory phenotype influences clinical characteristics and treatment response. Although induced sputum is the gold standard test for phenotyping asthma, a more accessible method is needed for clinical practice.


To investigate whether white blood cell counts and/or their derived ratios can predict sputum eosinophils or neutrophils in uncontrolled asthma.


This cross-sectional study evaluated 164 treated but uncontrolled asthmatic patients with sputum induction and blood collection. Receiver-operating characteristic (ROC) curves were used to assess the relationship between blood and sputum parameters.


There was a significant positive relationship between blood eosinophil parameters and the percentage of sputum eosinophil count. A weak but significant correlation was found between sputum neutrophil percentage and blood neutrophil percentage (r = 0.219, P = 0.005). ROC curve analysis identified that blood eosinophil percentage count was the best predictor for eosinophilic asthma, with an area under the curve (AUC) of 0.907 (P < 0.001). The optimum cut-point for blood eosinophil percentage was 2.7%, and this yielded a sensitivity of 92.2% and a specificity of 75.8%. The absolute blood eosinophil count was also highly predictive with an AUC of 0.898 (P < 0.0001) at a blood eosinophil cut-off of 0.26 × 109/L. The blood eosinophil/lymphocyte ratio (ELR) and eosinophil/neutrophil ratio (ENR) were increased in eosinophilic asthma, and the neutrophil/lymphocyte ratio (NLR) was increased in neutrophilic asthma. Neutrophilic asthma could also be detected by blood neutrophil percentages and NLR, but with less accuracy.

Conclusions and Clinical Relevance

Blood eosinophil counts and derived ratios (ELR and ENR) can accurately predict eosinophilic asthma in patients with persistent uncontrolled asthma despite treatment. Blood neutrophil parameters are poor surrogates for the proportion of sputum neutrophils. Blood counts may be a useful aid in the monitoring of uncontrolled asthma.
Keyword Asthma
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
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