Can severe asthma lead to COPD?

Overview

Severe and poorly controlled asthma can lead to damaged lungs which may increase the risk of developing chronic obstructive pulmonary disease (COPD). Symptoms of asthma and COPD may frequently co-exist in smokers and the elderly.

Features of both asthma and COPD can overlap in some patients initially diagnosed with either COPD or asthma alone. In the medical community, this may be called the “asthma-COPD overlap” (ACO). ACO is a description of clinical features, not a single disease.

Identifying patients with ACO is important to help guide treatment, but clinical features may differ from patient to patient. ACO is estimated to occur in roughly 2% to 3% of the general population, but is much higher in those first diagnosed with asthma (13% to 61%) or COPD (12% to 55%).

How do you diagnose ACO?

Asthma-COPD overlap (ACO) is not one defined disease but is most likely a combination of symptoms and mechanisms of airways disease. Outcomes can be worse for ACO compared to either asthma COPD alone. Specialized doctors such as a pulmonologist may be needed for diagnosis and treatment of patients.

Proposed diagnostic features of the “asthma-COPD overlap” (ACO) according to the Global Initiative for Asthma (GINA) include:

• Age 40 years or older
• Breathing symptoms such as shortness of breath upon exertion
• Spirometry (lung function tests): FEV1/FVC <0.7 or the lower limit of normal, with a bronchodilator increase in FEV1 >12% and 400 mL
• A history of asthma diagnosed medically
• A history of allergies or a genetic tendency to develop allergies (such as allergic rhinitis, asthma and eczema)
• Having a risk factor (≥10 pack years tobacco smoking, airborne pollutants)

In some cases, blood tests or a chest x-ray may be needed

How do you treat ACO?

There is limited randomized clinical trial data on how to treat patients with ACO, because their mixed symptoms often exclude them from clinical studies. More studies are needed in this patient group.

Pharmacologic (drug) therapies

General proposed drug therapies for ACO focus on treatments used in both asthma and COPD and are based on expert opinion from GINA and GOLD guidelines. Drug therapies are often used in stepwise fashion based on response, and include:

• Short-acting bronchodilators for as-needed relief (short-acting beta agonist, short-acting muscarinic antagonist, or a combination)
• Inhaled corticosteroids (ICS) in a low-to-moderate dose
• If symptoms warrant: a long-acting beta-agonist (LABA) / long-acting muscarinic antagonist (LAMA) to control additional symptoms.
• Combination ICS-LABA therapies can be used, but avoid use of long-acting beta-agonist (LABA) therapy alone (as in asthma).
• For persistent symptoms after a stepwise approach, other options may include triple therapy with LAMA-LABA-ICS or biologic agents developed for severe allergic asthma.

Non-drug therapies

Lifestyle and nondrug therapies are also a cornerstone of treatment in ACO, and include:

• Smoking cessation and avoidance of airborne pollutants
• Keeping vaccinations up to date (influenza, pneumococcal, COVID)
• Allergen avoidance, when possible
• Physical exercise, when appropriate
• Pulmonary rehabilitation
• Educational programs (inhaler technique, keeping active)

Learn more:

• Treatment of Asthma
• Treatment of COPD

Related Questions

• How long does an asthma attack last?
• What is considered severe asthma?
• How is severe asthma treated?

Bottom Line

• Severe and poorly controlled asthma can lead to damaged lungs which may increase the risk of developing chronic obstructive pulmonary disease (COPD).
• Features of both asthma and chronic obstructive pulmonary disease (COPD) can overlap in some patients initially diagnosed with COPD or asthma, and may be called the “asthma-COPD overlap” (ACO).
• Identifying patients with ACO is important to help guide treatment, but clinical features and appropriate treatments may differ from patient to patient. Drug treatments include agents used commonly in both asthma and COPD.