Differential Diagnosis of Asthma and COPD: Established and Emerging Biomarkers and Technologies.

Authors

Joan Cabot, Xavier Busquets, Joan B Soriano

Published in

Respiratory medicine. Pages 109124. Aug 28, 2026. Epub Aug 28, 2026.

Abstract

Asthma and chronic obstructive pulmonary disease (COPD) represent the two most prevalent chronic respiratory conditions worldwide, affecting hundreds of millions of individuals and imposing substantial morbidity and mortality. Despite their distinct biological mechanisms, these diseases frequently exhibit overlapping clinical features-including dyspnea, cough, and wheezing-that complicate differential diagnosis, particularly in smoking adults, older patients, and those with mild or fluctuating airflow obstruction. Spirometry remains the cornerstone of diagnostic evaluation, yet its limitations, including dependence on patient effort, reduced sensitivity for early disease, and inability to fully capture small airways involvement, contribute to persistent underdiagnosis and overdiagnosis in clinical practice. This review examines current diagnostic approaches for asthma and COPD, their inherent limitations, and the emerging biomarkers and functional technologies that may improve diagnostic precision. Established biomarkers, including blood eosinophils, fractional exhaled nitric oxide (FeNO), and induced sputum analysis, provide complementary information that refines clinical characterization but lack sufficient disease specificity for standalone use. Novel approaches, including lipidomics, metabolomics, and extracellular vesicle profiling, demonstrate potential for identifying disease-specific molecular signatures and biologically distinct phenotypes, particularly in asthma-COPD overlap. Concurrently, new functional tools-including novel spirometric indices such as Parameter D or FEV3/FEV6, respiratory oscillometry, and artificial intelligence-driven tidal breathing analysis-are enabling more sensitive, effort-independent, and multidimensional assessment of airway disease. The integration of these clinical, functional, inflammatory, and molecular approaches supports a transition toward multimodal diagnostic frameworks that may substantially improve the recognition and differential diagnosis of asthma and COPD, particularly in challenging clinical scenarios and early disease states.

PMID:
42665061
Bibliographic data and abstract were imported from PubMed on 29 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.