Worsening quality of life in asthmatics, non-obstructed smokers and ACO during the COVID-19 pandemic in patients from the ELSA-Brazil.

Publication date: Sep 24, 2025

Asthma-COPD Overlap (ACO) combines characteristics of both asthma and COPD, resulting in fixed airflow obstruction. During the COVID-19 pandemic, these patients may have experienced a decline in quality of life. To identify demographic, biochemical, and inflammatory markers and their relationship with quality of life during the COVID-19 pandemic in individuals with ACO. This was a cross-sectional study including 174 participants from the ELSA-Brazil study in ScE3o Paulo during the COVID-19 pandemic. Participants were allocated into four groups: control (n = 42), asthma (n = 42), Non-Obstructed Smokers (NOS) (n = 38), and ACO (n = 49). Quality of life was assessed using the SF-36 short, CAT, and WHOQOL-bref questionnaires. Complete blood count and C-Reactive Protein (CRP) were analyzed, and serum levels of interleukins IL-4, IL-5, IL-6, IL-8, IL-13, IL-17, and TNF-α were measured using Luminex analysis. Pre- and post-bronchodilator performance of FVC, FEV1, FEV1/FVC ratio, and FEF 25 %‒75 % was evaluated. Correlation analyses were conducted between interleukins and questionnaires, blood count, and spirometry results. Quality-of-life questionnaires showed poor mental, physical, and social health during the COVID-19 pandemic, with SF-36 indicating worsened functional capacity in the control and NOS groups, while CAT revealed a moderate impact in the ACO group. The asthma group had elevated IgE levels, and inflammation, as expressed by cytokines (TNF-α, IL-6, IL-8, IL-4, IL-17A, and IL-13), was highest in the NOS group. The ACO and asthma groups showed reduced post-bronchodilator values for FEV1, FEV1/FVC, and FEF 25 %‒75 %. Correlations were found between cytokines and quality of life, lymphocytes, leukocytes, neutrophils, and hemoglobin levels. During the pandemic, low quality of life levels were observed in all groups. IgE levels were higher in asthmatics, while the NOS group exhibited greater inflammation. Spirometry indicated lung function impairment in the asthma and ACO groups. Correlations were observed between inflammatory mediators, interleukins, and quality of life.

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