If you have COPD, you know that managing it effectively can be possible, yet it can be a challenge. We know, also, that its common for individuals with COPD to have other chronic conditions that overlap with COPD—comorbidities such as right-sided heart failure, coronary heart disease, obstructive sleep apnea syndrome (OSAS), depression, anxiety, and gastroesophageal reflux disease (GERD). But did you know that COPD can also overlap with asthma?
Asthma and chronic obstructive pulmonary disease (COPD) are common obstructive lung diseases. Some individuals with symptoms of COPD and asthma are diagnosed with asthma-COPD overlap syndrome (ACOS).
You may be thinking, good grief, aren’t COPD and my comorbidities enough for me to deal with, let alone the addition of another breathing condition? It's absolutely understandable that you may feel this way. But let’s slow down, take a look at this together, and sort it out.
How are COPD and asthma different?
We’ll start by comparing some aspects of COPD and asthma.
One of the major differences between COPD and asthma has to do with age. Asthma is usually noticed in children, showing up in episodes with symptoms of chest tightness, cough, wheeze, and shortness of breath. It is often linked with a history of skin irritation due to allergies. COPD is normally noticed in older individuals, with symptoms of increased shortness of breath, frequent coughing (with and without mucus), wheezing, tightness in the chest, and unusual tiredness. It is often associated with tobacco smoking.
Asthma tends to show up in episodes in between periods of times that are mostly symptom free. In asthma, airflow obstruction is reversible with medications. COPD, on the other hand, has symptoms of airflow obstruction that are daily and ongoing. Although symptoms are improved with medications, the airflow obstruction is not reversible.
What makes it ACOS?
So, we know that ACOS exists and some people who have COPD and some who have asthma have both conditions. That’s why it is called asthma-COPD overlap syndrome. But we don’t know specifically what factors go into determining if a person has ACOS. Some medical tests taken into account to determine what ACOS actually is, are: spirometry, eosinophilia* in the sputum, a personal history of asthma, smoking history, a family history of allergies with hypersensitivity reaction, immunoglobulin (IgE)** in the blood, a post-bronchodilator increase in FEV1, and carbon monoxide diffusion capacity (DLCO).
*An eosinophil is a type of white blood cell that plays an important part in the immunity of an individual. A high eosinophil count—eosinophilia—may indicate the presence of a variety of disorders, including asthma.
**An immunoglobulin is a protein found in the cells of the immune system that functions as an antibody, finding and fighting virus and bacteria. A high IgE count may indicate that a body is overreacting to some allergens.
What about treatment?
In general, inhaled corticosteroids (ICS) are the first line of treatment for persistent asthma, while inhaled bronchodilators (beta 2-agonists and anticholinergics—LABA, SABA (short-acting rescue inhalers for sudden symptoms), and LAMA—are routinely prescribed for individuals with COPD. In those with ACOS, a combination of medications may be prescribed depending on the symptoms and unique needs of each patient.
Non-medication treatments are essentially the same for those with ACOS as those with COPD alone: smoking cessation, pulmonary rehabilitation, influenza (flu), pneumonia, and COVID-19 immunizations, and the treatment of other comorbid conditions.
If you have COPD, asthma, or asthma-COPD overlap syndrome (ACOS), you can work in partnership with your doctor, preferably a pulmonologist, to find the best combination of medications and other treatments to help you control your symptoms and have your best possible quality of life.
What do you think? Do you, or anyone you know, have ACOS? Did you have asthma symptoms as a child? Are you surprised by anything you learned in this blog post?
Let’s talk! I look forward to hearing from you!
Freiler J. F. (2015). The Asthma-COPD Overlap Syndrome. Federal practitioner: for the health care professionals of the VA, DoD, and PHS, 32(Suppl 10), 19S–23S.
Centers for Disease Control and Prevention. Asthma in the US: CDC Vital Signs. CDC Website. [Accessed May 3, 2022]. http://www.cdc.gov/vitalsigns/asthma/.