Evaluation of C-Reactive Protein, Interleukin-6, and Neutrophil-Lymphocyte Ratio as Inflammatory Markers in Patients with Chronic Bronchitis Taking Oral Prednisolone in Maysan City Population


  • mohammed taha yaseen College of pharmacy/Almustansiriah university
  • Dalya Hanna College of pharmacy / Almustansiriah University
  • Ali Mohammed Hadi College of pharmacy, Basrah University, Basrah, Iraq.




Chronic bronchitis, CRP, IL-6, NLR


Background: Clinically, chronic bronchitis is defined as a persistent cough lasting at least three months over the course of two years in a patient where all other causes have been excluded. It is almost invariably described as a feature of Chronic Obstructive Pulmonary Disease (COPD) secondary to smoking.

Patients and methods: Ninety-five Iraqi patients newly diagnosed with chronic bronchitis were selected to participate in this study. Sixty patients (40 male and 20 female) were enrolled in the current study their ages were ranged from (40-65 years).

The patients were divided into two groups, in the first group (responders’ group) the patients were responded to oral prednisolone therapy, and in the other group the patients were not responded to oral prednisolone therapy (non-responders’ group). The assessment of responsiveness to prednisolone will be according to ATS (American Thoracic Society) which define the responders as those with a response of >12% baseline and >200 ml of FEV1. This study is a prospective observational clinical trial was carried out in thoracic consultant clinic at Al- Sader teaching Hospital in Maysan city from March 2022 until March 2023. The prednisolone tablets given in a dose of 30mg /day for 14 days.

Aim of the study: The current study was aimed to identify the association of the inflammatory markers C-reactive protein, interleukin-6 and neutrophils-lymphocytes ratio with the response of chronic bronchitis patients to oral prednisolone therapy.

Results and Conclusions: CRP, IL-6, and NLR consider as good predictive markers (P value<0.001) to determine the responsivity of patients with chronic bronchitis taking oral prednisolone tablets for 14 days.


- Dotan Y, So JY, Kim V. Chronic bronchitis: where are we now? Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation. 2019;6(2):178. DOI: https://doi.org/10.15326/jcopdf.6.2.2018.0151

- Choi JY, Yoon HK, Shin K-C, Park S-Y, Lee CY, Ra SW, et al. CAT score and SGRQ definitions of chronic bronchitis as an alternative to the classical definition. International journal of chronic obstructive pulmonary disease. 2019:3043-52. DOI: https://doi.org/10.2147/COPD.S228307

- Lim JU, Lee J-H, Kim T-H, Lee JS, Lee S-D, Oh Y-M, et al. Alternative definitions of chronic bronchitis and their correlation with CT parameters. International journal of chronic obstructive pulmonary disease. 2018:1893-9. DOI: https://doi.org/10.2147/COPD.S164055

- Lahousse L, Seys LJ, Joos GF, Franco OH, Stricker BH, Brusselle GG. Epidemiology and impact of chronic bronchitis in chronic obstructive pulmonary disease. European Respiratory Journal. 2017;50(2). DOI: https://doi.org/10.1183/13993003.02470-2016

- Widysanto A, Mathew G. Chronic Bronchitis. StatPearls [Internet]: StatPearls Publishing; 2021.

- Farag AH, Abass WA, Qassem HS. Evaluation the Effect of Sublingual Glutathione on the Quality of Life in COPD Patient by Using Saint George respiratory questionnaire. Al Mustansiriyah Journal of Pharmaceutical Sciences. 2023;23(2):140-6. DOI: https://doi.org/10.32947/ajps.v23i2.1015

- Huang X, Mu X, Deng L, Fu A, Pu E, Tang T, et al. The etiologic origins for chronic obstructive pulmonary disease. International journal of chronic obstructive pulmonary disease. 2019;14:1139-58. DOI: https://doi.org/10.2147/COPD.S203215

- Valipour A, Fernandez-Bussy S, Ing AJ, Steinfort DP, Snell GI, Williamson JP, et al. Bronchial rheoplasty for treatment of chronic bronchitis. Twelve-month results from a multicenter clinical trial. American Journal of Respiratory and Critical Care Medicine. 2020;202(5):681-9. DOI: https://doi.org/10.1164/rccm.201908-1546OC

- Woodruff PG, Van Den Berge M, Boucher RC, Brightling C, Burchard EG, Christenson SA, et al. American Thoracic Society/National Heart, Lung, and Blood Institute asthma–chronic obstructive pulmonary disease overlap workshop report. American journal of respiratory and critical care medicine. 2017;196(3):375-81. DOI: https://doi.org/10.1164/rccm.201705-0973WS

- Li J, Ye Z. The potential role and regulatory mechanisms of MUC5AC in chronic obstructive pulmonary disease. Molecules. 2020;25(19):4437. DOI: https://doi.org/10.3390/molecules25194437

- Lin VY, Kaza N, Birket SE, Kim H, Edwards LJ, LaFontaine J, et al. Excess mucus viscosity and airway dehydration impact COPD airway clearance. European Respiratory Journal. 2020;55(1). DOI: https://doi.org/10.1183/13993003.00419-2019

- Kim V, Criner GJ. Chronic bronchitis and chronic obstructive pulmonary disease. American journal of respiratory and critical care medicine. 2013;187(3):228-37. DOI: https://doi.org/10.1164/rccm.201210-1843CI

- Yang Z, Zhang Z, Lin F, Ren Y, Liu D, Zhong R, et al. Comparisons of neutrophil‐, monocyte‐, eosinophil‐, and basophil‐lymphocyte ratios among various systemic autoimmune rheumatic diseases. Apmis. 2017;125(10):863-71. DOI: https://doi.org/10.1111/apm.12722

- Khan NA, Daga MK, Ahmad I, Mawari G, Kumar S, Kumar N, et al. Evaluation of BODE index and its relationship with systemic inflammation mediated by proinflammatory biomarkers in patients with COPD. Journal of inflammation research. 2016:187-98. DOI: https://doi.org/10.2147/JIR.S108783

- Yazici O, Gulen S, Yenisey C, Eryilmaz U, Abas B, Polatli M. Comparison of inflammation biomarkers among chronic obstructive pulmonary disease groups: a cross sectional study. Nigerian Journal of Clinical Practice. 2020;23(6):817-24. DOI: https://doi.org/10.4103/njcp.njcp_222_19

- Leuzzi G, Galeone C, Taverna F, Suatoni P, Morelli D, Pastorino U. C-reactive protein level predicts mortality in COPD: a systematic review and meta-analysis. European Respiratory Review. 2017;26(143). DOI: https://doi.org/10.1183/16000617.0070-2016

- Al-Shammaa ZM, Ahmed FA. Association of Serum Leptin and C-Reactive Protein in Women with Breast Cancer. Al Mustansiriyah Journal of Pharmaceutical Sciences. 2018;18(1):128-34. DOI: https://doi.org/10.32947/ajps.v18i1.465

- Gupta N, Malhotra N, Ish P. GOLD 2021 guidelines for COPD—what’s new and why. Advances in respiratory medicine. 2021;89(3):344-6. DOI: https://doi.org/10.5603/ARM.a2021.0015

- Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary. American journal of respiratory and critical care medicine. 2017;195(5):557-82. DOI: https://doi.org/10.1164/rccm.201701-0218PP

- Nici L, Mammen MJ, Charbek E, Alexander PE, Au DH, Boyd CM, et al. Pharmacologic management of chronic obstructive pulmonary disease. An official American Thoracic Society clinical practice guideline. American journal of respiratory and critical care medicine. 2020;201(9):e56-e69. DOI: https://doi.org/10.1164/rccm.202003-0625ST

- Gundry S. COPD 1: Pathophysiology, diagnosis and prognosis. Nurs Times. 2019;116:27-30.

- Pandey S, Garg R, Kant S, Gaur P. Vitamin D, C-reactive protein, and oxidative stress markers in chronic obstructive pulmonary disease. Tzu-Chi Medical Journal. 2021;33(1):80. DOI: https://doi.org/10.4103/tcmj.tcmj_198_19

- Yan F, Pidayi M, Xia Y, Hu X, Yang Z. The prognosis value of C-reactive protein and endothelin-1 in chronic obstructive pulmonary disease patients with pulmonary artery pressure. Pakistan Journal of Pharmaceutical Sciences. 2019;32(4).

- Nieri D, Daniele M, Lombardi S, Bazzan E, Santerini S, De Cusatis G, et al. Circulating extracellular vesicles are associated with disease severity and interleukin-6 levels in COPD: a Pilot study. Journal of Clinical Medicine. 2021;10(21):5014. DOI: https://doi.org/10.3390/jcm10215014

- Huang H, Huang X, Zeng K, Deng F, Lin C, Huang W. Interleukin-6 is a Strong Predictor of the Frequency of COPD Exacerbation Within 1 Year. International journal of chronic obstructive pulmonary disease. 2021:2945-51. DOI: https://doi.org/10.2147/COPD.S332505

- Abd Elnaby EA, Abd Elnaiem SS, Mostafa AI, Sabry D, Alnaggar ARI, Haswa MK. Assessment of serum interleukin 6 level in patients with chronic obstructive pulmonary disease: is it related to disease severity? Egyptian Journal of Bronchology. 2019;13:575-9. DOI: https://doi.org/10.4103/ejb.ejb_50_19

- Ye Z, Ai X, Liao Z, You C, Cheng Y. The prognostic values of neutrophil to lymphocyte ratio for outcomes in chronic obstructive pulmonary disease. Medicine. 2019;98(28). DOI: https://doi.org/10.1097/MD.0000000000016371

- Guo R, Li J, Ma X, Pan L. The predictive value of neutrophil-to-lymphocyte ratio for chronic obstructive pulmonary disease: a systematic review and meta-analysis. Expert Review of Respiratory Medicine. 2020;14(9):929-36. DOI: https://doi.org/10.1080/17476348.2020.1776613

- Sayah W, Berkane I, Guermache I, Sabri M, Lakhal FZ, Rahali SY, et al. Interleukin-6, procalcitonin and neutrophil-to-lymphocyte ratio: Potential immune-inflammatory parameters to identify severe and fatal forms of COVID-19. Cytokine. 2021;141:155428. DOI: https://doi.org/10.1016/j.cyto.2021.155428

- Song W, Wang Y, Tian F, Ge L, Shang X, Zeng Q, et al. Clinical significance of procalcitonin, C-reactive protein, and interleukin-6 in helping guide the antibiotic use for patients with acute exacerbations of chronic obstructive pulmonary disease. Disease Markers. 2021;2021. DOI: https://doi.org/10.1155/2021/8879401

- Lin TL, Chen WW, Ding ZR, Wei SC, Huang ML, Li CH. Correlations between serum amyloid A, C‐reactive protein and clinical indices of patients with acutely exacerbated chronic obstructive pulmonary disease. Journal of Clinical Laboratory Analysis. 2019;33(4):e22831. DOI: https://doi.org/10.1002/jcla.22831




How to Cite

taha yaseen, mohammed, Hanna, D. ., & Hadi, A. M. (2024). Evaluation of C-Reactive Protein, Interleukin-6, and Neutrophil-Lymphocyte Ratio as Inflammatory Markers in Patients with Chronic Bronchitis Taking Oral Prednisolone in Maysan City Population. Al Mustansiriyah Journal of Pharmaceutical Sciences, 24(2), 127–136. https://doi.org/10.32947/ajps.v24i2.1034