Asthma-COPD Overlap

Asthma Symptoms

Symptoms of asthma can range from mild to severe and may come and go.

• Wheezing
• Coughing
• Tightness in the chest
• Shortness of breath

Severe asthma means your symptoms are not well controlled with common medicines, like inhalers.

You may need a different treatment plan to help you breathe better. Your doctor may check for other health problems.

Asthma Treatment

There is no cure for asthma, but it can be controlled.

Treatments may include:

• Inhalers taken every day to reduce inflammation and open the airways
• Inhalers to use when you’re having symptoms
• Immunotherapy such as allergy shots
• Biologic medications

With the right care, most people live normal and active lives.

What Is COPD?

Chronic obstructive pulmonary disease is a group of lung diseases, including emphysema and chronic bronchitis. The chronic nature of COPD means that airway obstruction is always present. Patients with COPD need long term management of their condition.

Unlike asthma, COPD is typically caused by exposure to substances that irritate the lungs. Smoking is the main cause of COPD. It can also be caused by fumes, dust, and other toxins.

COPD Symptoms

• Shortness of breath
• Frequent coughing (with or without mucus)
• Wheezing
• Chest tightness
• Feeling very tired

COPD Treatment

There are a variety of treatments to help patients with their COPD symptoms and reduce risk of exacerbations (attacks). Inhalers can deliver steroids to reduce the lung inflammation and different types of bronchodilators to open the airways. Some COPD patients may receive oxygen therapy. Biologic medications may be used for specific types of COPD caused by type 2 inflammation, particularly for patients experiencing frequent flares despite using standard treatments.

Smoking and COPD Risk

One of the most important things you can do to improve your lung health is to quit smoking.

Smoking can:

• Make breathing problems worse
• Reduce how well treatments work
• Shorten your life

Who Is at Risk for COPD?

COPD is more common in people who:

• Are age 40 or older
• Smoke, or used to smoke
• Have had severe asthma
• Breathe in harmful chemicals at work
• Have a family history of COPD

COPD affects women and men about equally in the U.S.

How COPD Is Diagnosed

Early diagnosis can help slow the disease. Your allergist will ask about your health history, perform a physical exam, and may recommend breathing tests such as spirometry to check how your lungs are working.

Your allergist may order imaging of your chest such as an X-ray or a CT scan. Sometimes these tests show enlarged lungs or air pockets in lung tissue when a person has COPD.

Eosinophilic COPD

Some people with COPD have higher levels of eosinophils, a specific type of white blood cells associated with type 2 inflammation. Patients with high eosinophils have a higher risk for exacerbations but are more likely to respond to certain medications. Steroid inhalers and biologic medications are more likely to be helpful in patients with elevated eosinophils.

About 1 in 3 people with COPD have higher levels of eosinophils. Eosinophil numbers can be easily checked with a simple blood test.

What Is ACO?

ACO stands for “asthma-COPD overlap.” The combination of asthma and COPD can be confusing. ACO is not a separate disease, but a way to identify patients who have both diseases. Since the symptoms are similar for both, it’s important to see an allergist for an accurate diagnosis and treatment plan.

ACO Symptoms

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

ACO affects about 2% to 4% of adults in the U.S., depending on how it’s defined. It is more common in older adults, smokers or former smokers, and women.

People with ACO have more flare-ups and hospital visits than patients with asthma or COPD alone. Although the conditions are similar, they have slightly different underlying processes and triggers which must all be managed.

How ACO Is Diagnosed

Asthma and COPD share many of the same symptoms. This can make it harder to diagnose.

Doctors may:

• Evaluate your symptoms and medical history and examine you carefully
• Perform allergy testing and check your blood counts
• Recommend breathing tests and imaging

Treatment and Management

COPD is a disease that gets worse over time, but treatment can help you feel better and stay active. Asthma can often be managed and stabilized with the right care.

The above treatments for asthma and COPD are both used to help patients with ACO.

If you have severe asthma or COPD, it is important to consider ACO, and see an allergist who can help you understand and manage both conditions.