Asthma-COPD Overlap | ACAAI Public Website

Symptoms

Signs of ACOS include:

• Difficulty breathing
• Wheezing
• Frequent coughing
• Tightness in the chest
• Excess phlegm
• Feeling tired
• Low physical tolerance for exercise
• Shortness of breath during routine activities

Although symptoms may not always be severe, ACOS is serious and can be deadly. In 2014, chronic lower respiratory diseases – primarily COPD – were the third leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. About 3,500 people die of asthma each year, nearly half of whom are age 65 or older.

People with asthma may not realize they also have COPD. Sometimes COPD isn’t diagnosed until it’s in the “moderate” stage, meaning they are experiencing frequent shortness of breath, coughing and heavier-than-normal mucus. Misdiagnosis can occur because the symptoms of COPD mimic those of asthma.

Triggers

Asthma triggers often include allergens, such as pollen, dust mites, cockroaches, molds and animal dander. Allergens can make COPD symptoms worse. And if left untreated, allergies and asthma can increase the chances for COPD in certain individuals. But COPD is not the same thing as asthma, and COPD is not caused by allergies or asthma. COPD is a collection of lung diseases. Sometimes asthma is part of the collection and sometimes it isn’t. However, COPD can result from long-term exposure to some of the same environmental risk factors – often in workplaces – that also can cause occupational asthma.

Smoking is the greatest risk factor for developing COPD. Smoking is a dangerous aggravation to all respiratory problems. It can decrease your life expectancy and interfere with your treatment plan. The most important thing you can do for your health is to stop smoking.

Diagnosis

When someone has ACOS it’s possible to mistake asthma for COPD or vice versa and fail to recognize the presence of both conditions. If you have either severe asthma or COPD, you should request further testing to find out if you have ACOS. When these two diseases overlap, both diseases need to be treated.

A diagnosis of severe asthma means that the symptoms of your asthma are not responding well to medications typically used to manage asthma, such as inhaled corticosteroids. You will need special care and treatment to try to improve lung function and manage symptoms. It’s important to consider other illnesses at this point to see if there are additional factors contributing to the diagnosis of severe asthma.

COPD is diagnosed most frequently among certain groups:

• People between the ages of 50 and 74
• Current and former smokers
• People with a history of severe asthma
• People with long-term exposure airborne irritants, including industrial chemicals and tobacco smoke
• People with a family history of COPD

While COPD has long been thought to be an ailment most frequently diagnosed in older white men, a 2013 report by the American Lung Association found that women are 37% more likely than men to have the disease and make up more than half the COPD deaths in the U. S.

Early diagnosis and treatment can change the course of the syndrome and slow its progression. An allergist can diagnose COPD and other conditions, such as asthma, by asking you about your medical history. Your allergist will also give you a physical exam that may include a quick breathing test, known as spirometry. This will measure how much air your lungs can hold and how quickly air moves in and out.

Your allergist also may suggest a chest CT scan and a chest X-ray. After determining the stage of your COPD and your asthma, ranging from mild to severe, your allergist will go over treatment options with you and discuss lifestyle changes and a treatment plan to help you feel better and improve lung function.

Treatment and Management

COPD is progressive, which means it gets worse over time. Asthma is a reversible condition when the right treatment is received at the right time. This makes early treatment important, especially when ACOS occurs.

If you have any signs of COPD, you should see an allergist. The earlier you get treatment, the better. Your allergist is specially trained to help you manage the chronic conditions of asthma, COPD or ACOS. It’s especially important to work with your allergist to manage symptoms and get the best care possible for your specific needs.

Treating ACOS isn’t a one-size-fits-all approach. Each patient receives a customized treatment plan. Treatment may include medication to reduce symptoms, supplemental oxygen and pulmonary (lung) rehabilitation. It may take some time to identify which medications work best for you. Lifestyle changes, such as exercise, breathing techniques and avoidance of air pollutants at home and at work, may also be recommended. For smokers, the most important part of treatment is quitting the use of tobacco.

Because respiratory illnesses such as the flu can cause serious complications in people with ACOS, you should get a yearly flu vaccine. A pneumococcal pneumonia vaccine is also recommended.

The sooner you see an allergist, the better. There is no cure for ACOS, and the early diagnosis of this syndrome can improve the overall health of your lungs. When more than one illness affects your breathing or if you have ACOS, your allergist will help you manage your symptoms and maximize your lung function. Don’t wait to find an allergist. Take steps now to improve your health and the quality of your life.

Asthma or COPD? How to Tell the Difference

Written by Laurie J. Watsoon

• Asthma and COPD: What’s the Difference, and Is There a Link?
• What Is Asthma-COPD Overlap?
• Who’s Likely to Have Asthma, COPD, or ACO?
• Asthma-COPD Link
• Symptoms
• Diagnosis
• Treatment
• More

Asthma and chronic obstructive pulmonary disease (COPD) are lung diseases. Both cause swelling in your airways that makes it hard to breathe.

With asthma, the swelling is often triggered by something you’re allergic to, like pollen or mold, or by physical activity. COPD is the name given to a group of lung diseases that include emphysema and chronic bronchitis.

Emphysema happens when the tiny sacs in your lungs (called alveoli) are damaged. Chronic bronchitis is when the tubes that carry air to your lungs (bronchial tubes) get inflamed. Smoking is the most common cause of those conditions (and COPD).

Asthma gets better. Symptoms can come and go, and you may be symptom-free for a long time. With COPD, symptoms are constant and get worse over time, even with treatment.

Some people have asthma and COPD at the same time. If you have symptoms of both diseases, your doctor may call it asthma-COPD overlap (ACO).

It’s possible to have symptoms of both asthma and COPD. ACO isn’t a separate disease. The name is a way to acknowledge the mix of symptoms.

It’s not clear what causes ACO. Having COPD for a long time may change the way your lungs work and make you more likely to get it. Or it might start if you smoke while you have asthma. It may also happen for reasons no one has figured out yet.

It’s important to find and treat ACO because it can be more serious than having either condition alone. There’s no cure, but you and your doctor can work together to help you breathe and live better.

People who smoke or breathe in pollution or chemicals at work for many years have higher chances of having COPD. That’s why the condition often starts in middle age or later in life.

Asthma is sometimes caused by gene changes that are passed down through families. If one of your parents has the disease, you’re more likely to have it.

Symptoms of asthma often start in childhood, and the condition is one of the most widespread long-term illnesses in kids. It affects about 1 in 10 children.

Besides a family history of the condition, a few things can raise your chances of asthma:

• Allergies
• Lung infections
• Smoking
• Being around chemicals or other irritants in the air

People who get ACO tend to be over 40 but younger than people with just COPD, and they have allergies (or have family members with them).

Researchers now know that childhood asthma greatly raises your chances for having COPD later on. Although many kids outgrow their asthma, some have lungs that don’t mature the way they should or work as well compared with people who’ve never had asthma.

Experts think asthma either causes COPD or is one of the factors that make COPD more likely in adulthood.

That’s especially true for kids who have “persistent childhood asthma.” Those children have trouble breathing almost every day. One study found that 11% of kids who had this kind of severe asthma had COPD as young adults.

What’s more, 3 out of 4 children with persistent asthma showed signs of lower lung capacity or growth by their early 20s. That could put them on a path to get COPD later. Boys are much more likely than girls to have problems with their lungs.

More research is needed to see if and which kind of treatment may help prevent childhood asthma from turning into COPD.

Since asthma and COPD both make your airways swell, they both can cause:

• Shortness of breath
• Cough
• Wheezing

One main difference is that asthma typically causes attacks of wheezing and tightness in your chest. COPD symptoms are usually more constant and can include a cough that brings up phlegm.

If you have ACO, you may also have:

• Flare-ups or times when symptoms get worse but usually get better with medicine that opens your airways, like a bronchodilator
• Neutrophils or eosinophils (white blood cells linked to inflammation) in your spit

With ACO, you’ll have more symptoms than with asthma or COPD alone, and you’ll have more severe attacks more often. You’ll need to go to the hospital more. But someone with ACO may have a better outlook than with COPD alone.

To figure out which condition you have, your doctor will start with a physical exam and questions about your medical history. They’ll look at your nose and throat and listen to your lungs with a stethoscope. They’re likely to ask about things like:

• Your symptoms
• If you have a family history of asthma or allergies
• If you smoke or are around secondhand smoke
• If you work around chemicals or other things that can irritate your lungs

Your doctor will also want to do a test called spirometry that checks how well your lungs work. You’ll blow into a mouthpiece, and a machine will measure how much air you can blow out and how fast you can do it.

If your doctor thinks you have asthma, they might ask you to breathe in a medicine called a bronchodilator and take the spirometry test again. If you have asthma, your lungs should work better after you take the medicine.

Another way to diagnose asthma is with a challenge test. You breathe in an asthma trigger like a strong scent or the drug methacholine. Then you take a spirometry test to see if your airways have narrowed. Weaker airflow afterward can be a sign that you have asthma.

If you had severe asthma as a kid or have a child who does, doctors recommend a spirometry test every year. The test may catch signs of a lung problem or early symptoms of COPD so you can get treated.

Tests used to diagnose COPD may also include:

• Chest X-ray. This uses radiation in low doses to make images of your lungs.
• Arterial blood gas test. This measures how much oxygen is in your blood. COPD can make your blood oxygen level drop.

If you have a fairly even mix of traits from both asthma and COPD, you may have ACO.

With asthma, symptoms come and go in the form of attacks. For some people, these may happen more often or be more serious over time.

Asthma medicines come in two types. Quick-relief medicines relax your airways to let more air into your lungs. You take them when you have an asthma attack to quickly stop wheezing and other symptoms.

• Short-acting beta-agonists relax the muscles around your airways.
• Anticholinergics both relax your airways and reduce the amount of mucus in your lungs.

Long-term medicines help keep asthma symptoms at bay. You take these medicines every day.

• Corticosteroids bring down swelling in your lungs. You breathe in the medicine through a device called an inhaler or take them as pills. Sometimes, they’re combined with one or more other medications.  
• Inhaled long-acting beta-agonists relax the muscles around your airways to help you breathe more easily. These are always used along with other asthma medications.
• Other anti-inflammatory drugs, such as cromolyn, help keep your airways from swelling up.
• Leukotriene modifiers are pills or liquids that block the process that causes airway swelling.
• Immunomodulators work directly on the immune system. These are also called biologics.
• Theophylline helps open your airways.
• Allergy shots or sublingual tablets are two types of immunotherapy that may help if your asthma is triggered by allergies.

COPD causes daily symptoms that get worse over time. Following a treatment plan can slow this down and help your lungs work better longer. COPD is treated with some of the same medicines as asthma, while others are different.

• Bronchodilators relax the muscles of your airways.
• Corticosteroids ease swelling inside your airways.
• Combination inhalers include both a corticosteroid and one or more bronchodilators to ease breathing in different ways.
• Phosphodiesterase-4 (PDE4) inhibitors bring down swelling in your lungs to prevent COPD flare-ups.
• Antibiotics treat infections that can make your COPD symptoms worse.

A few nondrug treatments can also help control COPD symptoms.

• Pulmonary rehabilitation. This program teaches you exercises and suggests changes in your diet and other tips to help you live better with COPD.
• Supplemental oxygen. If your lungs can’t pull enough oxygen into your blood, you may need to breathe in oxygen from a tank or machine.
• Surgery. Removing the damaged areas of your lungs can sometimes help the healthy parts work better.

Whether you have COPD, asthma, or both, it’s important to stop smoking. It’s also best to stay away from anything that irritates your lungs, such as:

• Spray chemicals like cleaning products and bug killers
• Allergens like mold, dust, and pollen
• Perfumes and other scents
• Secondhand smoke

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Bronchial asthma and COPD

COPD is a collective concept that unites a group of chronic diseases of the respiratory system: chronic obstructive bronchitis (COB), pulmonary emphysema (EP), severe bronchial asthma (BA).

COPD is also considered as a symptom complex with signs of terminal respiratory failure: FEV1<1.5 l or 30% of the proper value, i.e. progression of the disease, leading to the loss of the reversible component of bronchial obstruction, cor pulmonale. Most common (about 90%) the cause of COPD is COB, about 1% is pulmonary emphysema (due to deficiency of α1-antitrypsin), about 10% is due to severe BA.

Bronchial asthma is a chronic inflammatory disease of the respiratory tract, which involves mast cells, eosinophils and T-lymphocytes. In susceptible individuals, this inflammation leads to recurrent episodes of wheezing, shortness of breath, chest tightness, and coughing, especially at night and/or early morning. These symptoms are usually accompanied by widespread but variable obstruction of the bronchial tree, which is at least partially reversible spontaneously or under the influence of treatment. Inflammation also causes a friendly increase in airway response to various stimuli (c) GINA (Global Initiative for Asthma).

The spread of bronchial asthma.

1. More than 300 million people suffer from bronchial asthma.
2. The incidence of bronchial asthma in different countries ranges from 1% to 18% of the population (in Russia – 6.2%).
3. The maximum prevalence of bronchial asthma is observed in countries with a warm and damp climate, the minimum in the desert zone and in the Arctic.
4. Currently, there is an increase in the severity of the course of bronchial asthma.

Factors affecting the development and severity of asthma:

Mechanism of development of bronchial asthma:

1. Pathomorphology
   
   Inflammation of the respiratory tract
   
   Bronchial wall remodeling

2. Pathophysiology
   
   Airway narrowing
   
   Airway hyperresponsiveness

3. Special mechanisms
   
   Acute attack of disease
   
   Nocturnal asthma

Clinical picture.

The main symptoms of bronchial asthma are episodes of shortness of breath, wheezing, coughing and chest congestion. Of significant importance are: the appearance of symptoms after contact with the allergen, the seasonal variability of symptoms, the presence of relatives with bronchial asthma or other atopic diseases.

The main groups of drugs used to treat asthma:

β2 – adrenomimetics ( short-acting – fenoterol, medium-acting – salbutamol, long-acting – salmeterol, formoterol).

Effects of : Relaxation of the smooth muscles of the respiratory tract, suppression of the release of mediators from mast cells, increased mucociliary clearance, prevention of bronchospasm.

M-cholinolytics – Ipratropium bromide (atrovent).

Methylxanthines (short-acting – Theophylline, Eufillin, long-term – Teopak, Theophyllon).

Effects of : bronchodilation, membrane stabilizing effect, improvement of bronchial patency, positive ino-, chrono-, dromo- and batmotropic effects, excitation of the respiratory center, psycho-emotional arousal.

Mast cell membrane stabilizers ( sodium cromoglycate (intal), nedocromil sodium, ketotifen).

Used for basic therapy of mild bronchial asthma, prevention of bronchospasm caused by physical effort, inhalation of tobacco smoke, cold air G (Zileuton)

Glucocorticosteroids

Regulate gene expression, change the spectrum and amount of synthesized proteins, have an anti-inflammatory effect (PLA2, stabilization of lysosomal membranes), affect the activity of fibroblasts, reduce the migration of monocytes to the site of inflammation, inhibit the enzyme hyaluronidase

PUFAs (polyunsaturated fatty acids) are also used as a false substrate for the treatment of bronchial asthma.

COPD vs Asthma – Global Allergy & Airways Patient Platform

COPD vs Asthma: What’s the difference?

Asthma and COPD are chronic conditions that affect the airways and lungs, making it difficult to breathe. Distinguishing the two diseases can be difficult, and some people have signs and symptoms that are common to both diseases. However, accurate diagnosis is critical to ensure the most appropriate treatment and management.

What is asthma?

Asthma affects about 358 million people worldwide. In the United States, about one in 12 adults are diagnosed with the disease.

In asthma, the lining of the airways is sensitive, inflamed and swollen, producing excess mucus. In addition, the smooth muscles surrounding the airways contract. This leads to narrowing of the airways, a process called bronchospasm, which makes it difficult to breathe in and out.

What is COPD?

COPD describes a group of lung diseases, including bronchitis and emphysema, that cause our airways to narrow, making it difficult to breathe out.

Around 384 million people worldwide have COPD, although many remain hidden and undiagnosed. This is partly because COPD develops slowly over many years, meaning that for many, they don’t notice any symptoms until they are in their 50s.

Key differences between asthma and COPD

Narrowing of the airways is a sign of both COPD and asthma. In both cases, the symptoms may flare up and suddenly worsen – this is called an exacerbation. However, the processes involved differ as follows.

Causes and triggers

symptoms

Chronic respiratory symptoms common to asthma and COPD include shortness of breath, cough, chest tightness and wheezing. However, the picture of symptoms is different.

In COPD shortness of breath is present almost every day and makes physical activity difficult. It may be associated with cough and phlegm. Usually, COPD symptoms worsen over time.

Asthma symptoms vary with time and intensity. There may be long periods without symptoms.

Symptoms improve spontaneously or after treatment with inhaled bronchodilators/corticosteroids.

Age

Lung function test (spirometry)

Lung function test is a simple breathing test that measures how well your lungs are working. You will be asked to blow hard into a machine called a spirometer, which measures the total amount of air you can breathe out at one time and how quickly you can empty your lungs of air. People with healthy lungs can empty at least 70% of the air in their lungs in the first second of a sharp expiration – this measurement is called forced expiratory volume in 1 second (FEV1). A lower FEV1 score confirms the presence of airway obstruction – the lower your score, the higher the level of obstruction.

Treatment

General lifestyle advice includes quitting smoking, staying healthy, eating well and exercising appropriately.

Many of these asthma and COPD medications are the same as bronchodilators and anti-inflammatories given by inhaler and/or tablet. However, the two conditions have completely different treatment plans.

Can I have asthma and COPD?

Combined asthma plus COPD – sometimes referred to as “asthma and COPD overlap” – is not a separate disease. However, a person can have both asthma and COPD at the same time. It’s not clear how often this happens, and it has been reported in various studies that between one-tenth and one-half of people with asthma or COPD may have both conditions. The rates vary greatly depending on how old you are, your gender, and how the researchers set up their study.

Although COPD is rare in people under 40 years of age, the combined symptoms of asthma and COPD may appear in childhood or early adulthood.
More research is needed in people with asthma and COPD. However, we do know that people who experience a mixture of asthma-type and COPD-type symptoms often experience more distressing symptoms and flare-ups. They also tend to need additional medical care and their lung function deteriorates faster than those with either asthma or COPD alone.

How will I be treated if I have both asthma and COPD?

Your doctor treats your asthma first and foremost. You will be prescribed an inhaled corticosteroid to reduce the chance of a severe or life-threatening asthma flare-up, and they will probably add a bronchodilator later. Depending on how mild or severe your COPD symptoms are, you may need more drug and non-drug treatments for COPD.

Your doctor will review your symptoms, treatment, and how you feel during two or three months of treatment. You may need to see a hospital specialist if your diagnosis is still uncertain or if your symptoms have not improved as expected.

Can asthma lead to COPD later?

Not everyone with asthma develops COPD. However, having asthma in childhood or at a younger age can affect how well your lungs develop, and this may increase your chances of getting COPD as you get older. One recent study found that more than one in 10 children with persistent asthma (that is, they had symptoms every day) developed COPD at a young age.

This means that if you have asthma, it is even more important not to smoke. Quitting smoking will also help reduce your chances of developing COPD later in life.
Learn more:

• Asthma and smoking
• COPD and smoking

Resources

American Lung Association 2020.

BLF 2020. Asthma in children.

GINA 2017.

GINA 2021.

GOLD 2021.

GINA 2020. Online application.

Halpin DMG.