Asthma and COPD Overlap Syndrome

Hot Topic at Respiratory Meetings – Asthma and COPD Overlap Discussions about those individuals who have features of both asthma and COPD is a “hot topic” at medical meetings. It is important to understand this overlap, or combination, because different medications are used to treat asthma and to treat COPD (see below My Comment). In a medical article published on-line on August 20, 2015, in the journal CHEST, Dr. Cosio and colleagues from Spain identified individuals who were considered to have both asthma and COPD. This is called asthma-COPD overlap syndrome and abbreviated ACOS. The authors studied 831 patients diagnosed as having COPD. To identify those who also had asthma, they measured improvements in breathing tests after someone inhaled albuterol (a quick acting bronchodilator) and  examined blood tests that are usually positive in those with asthma, Main Findings: 15% of the group were considered to have both asthma and COPD (ACOS). They were predominantly male (82%) and 63% were taking an inhaled corticosteroid medicine.
Circles show overlap between asthma and COPD. COPD includes chronic bronchitis and emphysema.

Circles show overlap between asthma and COPD. COPD includes chronic bronchitis and emphysema.

My Comment: Why is this important to you? The main reason is that inhaled corticosteroid medications are used to reduce inflammation (redness and swelling) in the breathing tubes in those with asthma. Rather, different types of inhaled bronchodilators are used to treat  those with COPD. Inhaled corticosteroids should be used to treat COPD mainly for those who have experienced frequent episodes of worsening of COPD usually due to a chest infection (called an exacerbation). One concern about use of inhaled corticosteroids in the treatment of COPD is an increased risk of pneumonia. With any medication, there needs to be consideration of expected benefit and possible risk. You may wish to discuss this topic with your healthcare provider.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.