Sputum eosinophils can help define the diagnosis in patients with common features of asthma and COPD

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Background: in patients with airway obstruction, characteristics common to asthma and COPD (ACO) may coexist, thus the correct phenotyping can be complex. In 2019 a population of ACO patients with airway obstruction was fully studied: respiratory function test, chest X-ray, St George’s Respiratory Questionnaire, Medical Research Council dyspnea test, Skin prick tests, cytological evaluation of induced sputum, FeNO and blood eosinophils count Aim: to understand how many patients were definitively categorized with Asthma or COPD 5 years after the evaluation Methods: of 51 probable ACO, followed up for 5 years after the comprehensive evaluation, we evaluated the time taken to reach a defined diagnosis, studying retrospectively which assessments could predict the correct future diagnosis Results: 47 patients out of 51 probable ACO who underwent the 2019 evaluation had an active follow-up in 2025: 24 were diagnosed with asthma, 20 with COPD and 3 remained suspected ACO. Mean time to diagnosis from 2019 was 2,6 years. 95% of COPD patients were smokers or former smokers compared to 65% of asthma patients. The most significant variable were: increased eosinophil count in sputum (Asthma 25.8 cells, COPD 6.9 cells, ACOS 5.5 cells); FeNO was higher in patients with asthma and ACO compared to COPD (32,8 and 47,5 vs 15,5); blood eosinophil cell counts was higher in patients with asthma (mean 0.29) compared to COPD (mean 0.16) Conclusions: a correct and comprehensive diagnostic work up (complete with FeNO, eos cell counts in blood and sputum) and an adequate follow-up can help clinician in reaching a correct diagnosis on time, especially in patients presenting common features of asthma and COPD

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