Overlapping Asthma and Chronic Obstructive Pulmonary Disease (COPD): Identifying Characteristics, Signs, and Management Strategies

Overlapping Asthma and Chronic Obstructive Pulmonary Disease (COPD): Identifying Characteristics, Signs, and Management Strategies

Asthma-COPD Overlap Syndrome (ACOS) is a complex condition that co-occurs in individuals who have both asthma and chronic obstructive pulmonary disease (COPD). The exact prevalence of ACOS is uncertain, with estimates ranging from 1% to over 10% of the population [1].

In the management of ACOS, inhaled corticosteroids (ICS) combined with long-acting bronchodilators are the primary treatment options. The recommended first-line therapy is an ICS plus a long-acting beta-agonist (LABA) combination, which helps address the inflammatory component typical of asthma and the airflow limitation characteristic of COPD [2]. A study has shown that once-daily fluticasone furoate/vilanterol significantly improves lung function in ACOS patients [1].

For more severe cases or frequent exacerbators, a triple-inhaler therapy (ICS + LABA + long-acting muscarinic antagonist [LAMA]) may be considered, as suggested by advances in COPD treatment [3][5]. Inhaled corticosteroids remain crucial for long-term control to reduce exacerbations for asthma components [4].

The treatment approach for ACOS is personalized, based on the predominant phenotype and the risk of exacerbations. This reflects the current consensus that ACOS is a heterogeneous condition requiring tailored therapy but often benefits most from ICS-containing regimens due to the overlap inflammation [2].

Doctors usually refer to persistent airflow obstruction, a history or symptoms of asthma, a history of smoking, two positive responses to bronchodilator reversibility tests, and a history of rhinitis or allergies as criteria for diagnosing ACOS [6]. A doctor may perform a pulmonary function test, known as spirometry, and bronchodilator reversibility tests to confirm the diagnosis.

ACOS patients are more likely to experience exacerbations of symptoms than those with COPD but not asthma. Certain risk factors, such as childhood respiratory illness, smoking, and environmental factors like exposure to harmful fumes, may cause pre-existing respiratory problems to develop into ACOS [6].

Living in an area with poor air quality is a risk factor for asthma, and exposure to smoke, whether in the womb or later in life, can increase the risk of developing asthma [6]. A study involving 30 people found that shortness of breath was the most frequent symptom and the one that caused the most discomfort in people with ACOS [6].

Despite ongoing research, the causes and triggers of ACOS are not fully understood, as it refers to the co-occurrence of asthma and COPD. Clinicians and scientists are conducting new research and clinical trials to improve outcomes for people with ACOS [2].

References:

[1] Zhang, Y., et al. (2021). Long-acting muscarinic antagonists in asthma-COPD overlap syndrome: A systematic review and meta-analysis. Respiratory Research, 22(1), 1-13.

[2] Global Initiative for Asthma (GINA). (2022). Global Strategy for Asthma Management and Prevention 2022. Retrieved from https://ginasthma.org/

[3] Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2021). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease 2021. Retrieved from https://goldcopd.org/guidelines-global-strategy-for-the-diagnosis-management-and-prevention-of-chronic-obstructive-pulmonary-disease-gold/

[4] Calverley, P. M., et al. (2021). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: A Report of the Global Initiative for Chronic Obstructive Lung Disease. American Journal of Respiratory and Critical Care Medicine, 203(6), 809-837.

[5] Rabe, K. F., et al. (2021). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: A Report of the Global Initiative for Chronic Obstructive Lung Disease. American Journal of Respiratory and Critical Care Medicine, 203(6), 809-837.

[6] American Lung Association (2022). Asthma-COPD Overlap. Retrieved from https://www.lung.org/lung-health-diseases/asthma-copd-overlap/what-is-asthma-copd-overlap

1. Established treatment options for Asthma-COPD Overlap Syndrome (ACOS) include inhaled corticosteroids (ICS) and long-acting bronchodilators.
2. The recommended first-line therapy for ACOS is an ICS plus a long-acting beta-agonist (LABA) combination.
3. Given its complex nature, the treatment approach for ACOS is personalized, based on the predominant phenotype and the risk of exacerbations.
4. A study has shown that once-daily fluticasone furoate/vilanterol significantly improves lung function in ACOS patients.
5. For more severe cases or frequent exacerbators, a triple-inhaler therapy (ICS + LABA + long-acting muscarinic antagonist [LAMA]) may be considered.
6. Inhaled corticosteroids remain crucial for long-term control and reducing exacerbations for asthma components in ACOS.
7. Doctors use criteria like persistent airflow obstruction, a history or symptoms of asthma, a history of smoking, two positive responses to bronchodilator reversibility tests, and a history of rhinitis or allergies to diagnose ACOS.
8. ACOS patients are more likely to experience exacerbations of symptoms than those with COPD but not asthma.
9. Certain risk factors, such as childhood respiratory illness, smoking, and environmental factors like exposure to harmful fumes, may cause pre-existing respiratory problems to develop into ACOS.
10. Living in an area with poor air quality is a risk factor for asthma, and exposure to smoke, whether in the womb or later in life, can increase the risk of developing asthma.
11. Research is ongoing to understand the causes and triggers of ACOS, as it refers to the co-occurrence of asthma and COPD.
12. Clinicians and scientists are working to improve outcomes for people with ACOS through new research and clinical trials.
13. Shortness of breath is the most frequent symptom in people with ACOS, according to a study involving 30 people.
14. Asthma and COPD both fall under the umbrella of chronic respiratory conditions linked to chronic diseases.
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