Asthma and COPD overlap syndrome

Question 1

ACOS

What is it?

Answer 1

a chronic and inflammatory respiratory disorder characterised by the combination of asthma and COPD

Question 2

ACOS

What are some triggers?

Answer 2

• Tobacco smoke
• Cold air
• Exercise
• Allergens
• Air pollutants
• Viral infections

(similar to asthma and COPD)

Question 3

ACOS

What are the symptoms and why do these symptoms come about?

Answer 3

dyspnoea, wheezing, cough, and frequent exacerbations

worse than in pt with asthma or copd alone

due to bronchi narrowing

Question 4

ACOS

What are some risk factors?

Answer 4

smoking
respiratory irritants

Question 5

ACOS

What are some differentials?

Answer 5

• Isolated asthma or COPD
• Heart failure
• Bronchiectasis
• Interstitial lung disease

Question 6

ACOS

How might we investigate for it?

Answer 6

spirometry
* Persistent airflow limitation (FEV₁/FVC < 0.7)
* Partial reversibility to bronchodilators, indicating features of asthma.

bronchoprovocation test

PEF

Inflammatory biomarkers like blood eosinophils and FeNO (fractional exhaled nitric oxide) can help identify the asthmatic component.

Imaging, such as a CXR, may show features of emphysema or chronic bronchitis, which are characteristic of COPD.

Question 7

ACOS

Name some signs of severe ACOS exacerbations.

Answer 7

• Tachypnoea
• Tachycardia
• Use of accessory muscles to breathe
• Sweating
• Extreme dyspnoea
• Cyanosis

Question 8

ACOS

Give an overview of emergency management of acute ACOS exacerbation.

Answer 8

• Resolving airflow obstruction with inhaled bronchodilators.
• Administering systemic corticosteroids to reduce inflammation.
• Providing supplemental oxygen to correct hypoxaemia.

Question 9

ACOS

What pharmacological treatments are used to manage ACOS?

Answer 9

inhaled ICS + LABA
(if symptoms persist
add LAMA)

rapid relief:
short-acting bronchodilators

LABA
* Fluticasone propionate with salmeterol (Seretide)
* Budesonide with formoterol (Symbicort)

LAMA
* Tiotropium (Spiriva)

short-acting bronchodilators
* Short-acting beta-agonist (SABA) such as salbutamol (Ventolin)
* Short-acting muscarinic antagonists (SAMA) such as ipratropium bromide (Atrovent)

Question 10

ACOS

What is some non-pharmaceutical management options?

Answer 10

• Regular monitoring of lung function and symptoms.
• Patient education regarding inhaler techniques and recognising exacerbations.
• Smoking cessation.
• Avoidance of respiratory irritants and allergens.
• Vaccinations for influenza and pneumonia to reduce the risk of exacerbations.