Feature Article

Asthma-COPD overlap: implications for patient management

Alistair Cook, Jodie Simpson, Peter Wark

Figures

© sdominik/istockphoto.com model used for illustrative purposes only
© sdominik/istockphoto.com model used for illustrative purposes only

Abstract

Asthma-COPD overlap (ACO) is characterised by persistent airflow limitation with features typically associated with both asthma and chronic obstructive pulmonary disease (COPD). Because there is no universally accepted definition of ACO, reliable data on managing patients exhibiting ACO is lacking. An approach to treating chronic airways disease that targets identifiable clinical traits rather the disease label is increasingly recommended.

Key Points

  • The term asthma-COPD overlap (ACO) was proposed to reflect the overlapping aetiologies and clinical features of asthma and chronic obstructive pulmonary disease (COPD) and the large population of patients who demonstrate features of both.
  • Clinical features and underlying inflammatory and physiological mechanisms of asthma and COPD are highly variable and affect the utility of the ACO umbrella in clinical practice. This heterogeneity limits both high-quality research on the subject and treatment recommendations specific to ACO.
  • Initiation of inhaled corticosteroids is recommended in patients who clearly demonstrate features of both asthma and COPD, as this is a critical component of asthma control.
  • An individualised approach to treatment, with a focus on identifying and treating disease traits is more important than managing disease labels, and will lead to better overall care of the patient with chronic airway disease.

Figures

© sdominik/istockphoto.com model used for illustrative purposes only
© sdominik/istockphoto.com model used for illustrative purposes only