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Asthma COPD overlap syndrome (ACOS) – How to treat it


Asthma is considered serious when it is difficult to manage the symptoms and treat. Asthma-COPD overlap syndrome (ACOS) is when you have signs or symptoms of both chronic obstructive pulmonary disease (COPD) and asthma. 

Asthma is a chronic lung disorder that causes the narrowing of the airway, mucus production, and inflammation in the airways. Some symptoms of asthma are tightening in the chest, wheezing, difficulty in breathing, and shortness of breath. Sometimes the symptoms are worse than usual.             

Chronic obstructive pulmonary disease (COPD) is a collection of lung disorders that cause breathing problems and block airflow. Many people with COPD don’t have asthma and most people with asthma do not develop COPD.

These groups of disorders can include serious asthma, chronic bronchitis, emphysema. Asthma-COPD overlap syndrome (ACOS) is not a separate disease, but relatively a way for doctors to understand the mix of symptoms and select a treatment plan that is most suitable for you.

Symptoms of Asthma-COPD overlap syndrome

Symptoms of Asthma-COPD overlap syndrome (ACOS) include:

  • Difficulty Breathing
  • Frequent Coughing
  • Tightness in the chest
  • Excessive phlegm
  • Wheezing
  • Shortness of breath

Symptoms of Asthma COPD overlap syndrome (ACOS), may not always be severe. It varies from day to day. According to the Centers for Disease Control and Prevention, In 2014, chronic lower respiratory diseases – primarily COPD – were the third leading cause of death in the U.S.

Each year about 3500 people die due to asthma, half of whom are age 65 or more. Asthma-COPD overlap syndrome (ACOS) is serious and can be deadly. You can be symptom-free for a long time and symptoms change often if you have only asthma. Asthma can start in adulthood, but it usually begins in childhood.

If you only have a chronic obstructive pulmonary disease (COPD), symptoms usually start after age 40. Most people with COPD also have a history of smoking. Asthma COPD overlap syndrome (ACOS) shares characteristics of both asthma and COPD.


Triggers of asthma often include allergens, such as cockroaches, pollen, dust mites, molds, and animal dander. These allergens can make COPD symptoms bad. Allergies and asthma can increase the chances of COPD in certain individuals if left untreated.
Experts don’t know why some people develop asthma. You might be more likely to have asthma if:

  • If you have a family history of asthma or allergies
  • You had a respiratory infection in childhood
  • If you have a personal history of allergies
  • You are regularly exposed to irritants such as tobacco smoke

Chronic obstructive pulmonary disease (COPD) is caused by long-term exposure to lung irritants. Cigarette smoke is the most common cause of COPD in the United States. Pipe smoke, Secondhand smoke, and Cigar smoke can cause COPD too.

Smoking is dangerous to all respiratory problems. Chemical fumes, cooking fumes, and air pollution can also trigger this.

How to diagnose Asthma COPD overlap syndrome (ACOS)?

ACOS means you have symptoms of both COPD and asthma. Your doctor may diagnose COPD, asthma, or ACOS. If you have either COPD or severe asthma, you should request further testing to find out if you have ACOS. When these two disorders overlap, both diseases need to be treated.

Researchers are still trying to understand when asthma and COPD overlap. A doctor can diagnose COPD and other situations, such as asthma, by reviewing your medical history. Your doctor will perform a physical exam known as, spirometry, which may include a quick breathing test. Your doctor also may suggest a chest CT scan and chest X-ray.

After determining the stage of your conditions (COPD and Asthma) from mild to severe, your doctor will go over the treatment options with you. 

Treatment and Management

COPD gets worse with time. While asthma is a changeable condition when the right treatment is received at the right time. This makes early treatment important, particularly when Asthma-COPD overlap syndrome (ACOS) occurs.

If you see any symptoms of COPD, you should contact your doctor very soon. They are specially trained to help you manage the severe condition of asthma, COPD, and Asthma-COPD overlap syndrome (ACOS).

Careful management and adherence to therapy are required in ACOS. Following are the people you might  have on your healthcare team:

  • Doctors
  • Nurses
  • Respiratory therapist
  • Nutritionist
  • A physical therapist or exercise expert
  • Dietitian

There are three types of medicines available today that can help improve symptoms of Asthma-COPD overlap syndrome (ACOS).

  • Low-dose inhaled corticosteroid (ICS), is a common long-term control medicine for asthma. It is helpful in treating the ongoing inflammation in the airways.
  • A bronchodilator is a long-term control medicine for asthma. It keeps the airways open for a long period of 14-24 hours. This type of medicine should be used combined with another medication that treats inflammation.
  • A long-acting muscarinic agonist (LAMA), is used to treat COPD symptoms. The most important part of treatment for smokers is, quitting the use of tobacco.

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