Overlap of asthma and COPD

COPD and asthma can coexist. Many patients with COPD report a history of asthma, and people with a history of asthma are at increased risk of developing COPD. Differentiating the diagnosis can be difficult because symptoms are similar.

Clinical features favouring COPD include:

  • onset after age 40
  • persistent airflow limitation (as opposed to the variable airflow limitation typical of asthma)
  • lack of response to asthma therapy (eg symptoms persisting after several weeks or months of inhaled corticosteroid [ICS] treatment)
  • heavy tobacco smoke exposure.

Clinical features favouring asthma include:

  • onset before age 20
  • significant day-to-day variability in airflow limitation and symptoms
  • normal lung function between symptoms
  • symptoms worse at night or in the early morning
  • family history of asthma or atopy
  • seasonal variability in symptoms
  • spontaneous improvement in symptoms.

Patients with features of both conditions may have overlap of asthma and COPD. These patients experience more rapid disease progression than those with either disease alone. They also have worse health-related quality of life, and experience more frequent and severe respiratory exacerbations.

Seek specialist advice for managing patients with overlap of asthma and COPD, as evidence is limited and approaches differ.

Note: Patients with overlap of asthma and COPD have more rapid disease progression, and require specialist management.

ICS have a key role in preventing asthma-related deaths in patients with asthma, and long-acting beta2 agonists (LABAs) have a significant role in COPD management. Use an ICS and long-acting bronchodilator combination in patients with overlap of asthma and COPD; avoid monotherapy.