Aim: To evaluate the role of the Neutrophil-to-Lymphocyte Ratio (NLR) as a biomarker for predicting acute exacerbations in COPD (AECOPD) based on current literature. Background: Chronic obstructive pulmonary disease (COPD) is one of the leading cause of morbidity and mortality worldwide. Acute exacerbations (AECOPD) have led to a major impact on patient health, which in turn lead to hospitalizations and also an increased risk to disease burden. Thus in order to optimize treatment stratergies, one have to identify those reliable biomarkers that help predict exacerbations. The neutrophil-to-lymphocyte ratio (NLR) has been a potential indicator to assess inflammation in COPD patients [1-6]. Review Results: This review critically examines six key studies on NLR and COPD exacerbations, assessing both its clinical utility as well as its limitations. Several studies have found a link between higher NLR and an increased risk of COPD exacerbations. However, changes in cutoff values, study designs and confounding factors like corticosteroid use may have an impact on prediction accuracy [1-6]. Conclusion: The NLR is a promising biomarker for determining AECOPD risk. However, consistent cutoff values and multi marker techniques are necessary for clinical use.