Asthma-COPD Overlap Syndrome

Asthma is a chronic condition that causes inflammation of the lungs. Inflammatory swelling of the tissues in the walls of the bronchial tubes and excessive mucus secretion within the lumen of the bronchial tubes cause blockage to the free flow of air in and out of the lungs during normal respiration. In some instances, asthma is a genetically determined condition which can be aggravated by environmental factors such as exposure to allergens (e.g., dust mites, molds, pollens, pet dander, cockroaches) and/or irritants (e.g., cigarette smoke, strong scents, air pollution, increased humidity, cold air). The usual symptoms of asthma may include coughing, chest tightness, shortness of breath, and wheezing.

The course of the disease varies widely in individual patients depending on the severity of the condition. Some individuals have symptoms all of the time and their asthma is labeled persistent while others only have symptoms sporadically and thus their asthma is categorized as intermittent. Physical exertion and both upper and lower respiratory infections may increase the frequency and severity of asthma symptoms in susceptible patients. Asthma usually begins in childhood although it may begin in adulthood. Asthma is usually associated with other allergic disorders such as hay fever (i.e., allergic rhinitis) and/or eczema (i.e., atopic dermatitis).

Chronic obstructive pulmonary disease or COPD is a common, preventable, and treatable condition that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. Chronic bronchitis and emphysema are the two most common conditions that fall under the umbrella of COPD. Persistent coughing associated with expectoration and increasing difficulty in breathing as well as effort intolerance are the usual symptoms.

COPD is a progressive condition and it is very common to have increasing severity over time. COPD symptoms typically begin after the age of 40, although symptoms may appear earlier. The symptoms may vary from day to day, but they are chronic even with treatment. Most individuals with COPD also have a history of smoking or smoke exposure.

Asthma-COPD overlap syndrome (ACOS) is characterized by persistent airflow limitation with several features usually associated with both asthma and COPD. ACOS is therefore identified in clinical practice by the features that it shares with both asthma and COPD.
Individuals with ACOS may experience wheezing, breathing difficulties, fatigue, and/or excessive mucus that often responds to bronchodilators (i.e., medications that open airways such as albuterol). Patients with asthma-COPD overlap syndrome also seem to experience more shortness of breath than individuals with COPD or asthma alone. “Persistent airflow obstruction with features of asthma” is a common way that this condition is defined. They tend to be younger in age than patients with COPD alone. However, because this condition is still being studied, experts do not yet agree on a single way to define the syndrome.

ACOS generally involves these 3 features compared with people who have COPD alone:

  • more of a response to inhaled bronchodilators
  • increased reversibility of airflow
  • bronchial and systemic inflammation from eosinophils (i.e., a type of white blood cell that is often elevated in allergic conditions).

The diagnosis of asthma-COPD overlap syndrome requires a comprehensive history and physical examination. Pulmonary function tests (i.e., spirometry) are also usually obtained. One may also need imaging studies such as a chest X-ray and/or CT scan.

The treatment of ACOS generally includes:

  • Avoidance of allergens and irritants
  • Total cessation of smoking
  • Medications which usually consist of daily maintenance inhaled corticosteroids which are anti-inflammatory, in combination with inhaled long-acting bronchodilators to keep the airways open, and short-acting bronchodilators to provide quick relief from symptoms during flare-ups
  • Regular immunizations such as Influenza and pneumonia vaccinations
  • Pulmonary rehabilitation (i.e. breathing exercises and healthy eating habits)

The board certified allergists at Black & Kletz Allergy have 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area and are very experienced in the diagnosis and treatment of asthma and asthma-COPD overlap syndrome. We also work in concert with any pulmonologist on patients with COPD. Black & Kletz Allergy treat both children and adults and have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We offer on-site parking at each location. The Washington, DC and McLean, VA offices are Metro accessible and there is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. Please call our office to make an appointment or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy has been serving the Washington, DC metropolitan area for more than 50 years and we pride ourselves in providing exceptional allergy and asthma care in a professional and caring environment.