What Is Asthma-COPD Overlap Syndrome?

By Richard Asa and Temma Ehrenfeld @temmaehrenfeld
February 08, 2023
What Is Asthma-COPD Overlap Syndrome?

Asthma-COPD overlap may be common, but doctors are debating exactly how to define and treat it. Here's what you should know.

Asthma and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis, make breathing a struggle. When you have symptoms of both, your doctors may diagnose you with asthma-COPD overlap syndrome, meaning you have overlapping symptoms of both illnesses.

A history of smoking at least one pack a day for 10 years is usually important for a diagnosis of COPD.  People with asthma who smoke are at risk of the overlapping syndrome.

Depending on the definition, up to 40 percent of COPD patients may have asthma symptoms as well and between 15 and 35 percent of asthma patients may fit this category.


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Symptoms of asthma-COPD overlap syndrome

People diagnosed with this condition are about twice as likely to have dangerous asthma flare-ups when they struggle to breathe as for people with COPD alone.

You may have:

  • Tight chest
  • Coughing with mucus
  • Fatigue
  • Frequent shortness of breath
  • Wheezing

“Discussions about those individuals who have features of both asthma and COPD is a hot topic at medical meetings,” says Donald A Mahler, MD, a practicing pulmonologist and emeritus professor at Dartmouth University. “It is important to understand this overlap, or combination, because different medications are used to treat asthma and to treat COPD.”

COPD is treated with short-acting inhaled bronchodilators, which relax and widen your airways. Asthma is treated with corticosteroids that, when used daily, make asthma symptoms less likely to occur.

Mahler believes that inhaled corticosteroids should be used to treat COPD “mainly for those who have experienced frequent episodes of worsening of COPD due to a chest infection (exacerbation).” But he adds that use of the corticosteroids to treat COPD increases risk of pneumonia.

Very few clinical trials have evaluated therapy for patients with this condition, and they are generally excluded from clinical trials of COPD or asthma.

The tendency is to focus on which of the two illnesses is most prominent in an individual patient. Compared to COPD patients, patients with asthma-COPD overlap are more likely to suffer from obesity, which affects breathing, and have smoked more mildly.

First-line treatment is often the asthma remedy, long-acting corticosteroids.

Many patients with asthma are at risk of developing COPD from a cascade of inflammation and protein breakdown that causes lung tissue damage. While that phenomenon is common in smokers, why it also happens in nonsmokers is unclear.

There is a meeting of the minds on one aspect of the syndrome: It’s unpleasant.

“There is broad agreement that patients with features of both asthma and COPD experience frequent exacerbations, have poor quality of life, a more rapid decline in lung function and high mortality,” according to the Global Initiative for Asthma.

Help for you may come from the Global Initiative for Chronic Obstructive Lung Disease.

Patients with any of the three chronic diseases will cough a lot, have labored breathing, wheeze, and experience chest tightness. Your doctor can sometimes differentiate the diseases by knowing the age of onset and the triggers.

Asthma tends to strike younger patients and those with a family history of the disease, for example. It’s triggered by cold weather, smoke fumes, exercise, among other substances.

COPD tends to be triggered by respiratory infections.

Also, you may never have smoked and still have asthma, but COPD and asthma-COPD overlap patients have a history of smoking or exposure to biomass fuels, burning wood, or other substances used to cook or heat.


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February 08, 2023

Reviewed By:  

Christopher Nystuen, MD, MBA and Janet O'Dell, RN