Asthma COPD overlap syndrome

Question 1

What is meant by “asthma- COPD overlap syndrome”?

Answer 1

Asthma-COPD overlap syndrome (ACOS) is characterized by persistent airflow limitation with several features usually associated with asthma and several features usually associated with COPD.

Question 2

What are the risk factors of ACO syndrome?

Answer 2

Risk factors for getting asthma: 
- have a family history of allergies or asthma 
- smoking
- have a personal history of allergies, especially if they developed in early childhood 
- had respiratory infections as a child 
- Single biggest risk factor for COPD is smoking. Having asthma doesn’t mean you’ll develop COPD. But children with severe, persistent asthma are 32 times more likely to develop COPD later in life.

Question 3

What are the presenting symptoms of ACO syndrome?

Answer 3

• Difficulty breathing 
• Wheezing 
• Excess mucus 
• Feeling tired 
• Frequent coughing 
• Frequent shortness of breath 

Question 4

What signs of ACO syndrome can be found on physical examination?

Answer 4

• Tachypnoea 
• Use of accessory muscles 
• Prolonged expiratory phase 
• Polyphonic expiratory wheeze on auscultation 
• Hyperinflated chest and hyper-resonant percussion, decreased air entry 
• Harrison’s sulcus in chronic asthma 
• Respiratory distress  
• Barrel-shaped over-inflated chest 
• Decreased cricosternal distance 
• Cyanosis 
• Pursed-lip breathing 
• Tar staining 

Question 5

What investigations are used to diagnose/ monitor ACO syndrome?

Answer 5

ACOS involves 3 features compared with COPD alone:
1. more of a response to bronchodilators
2. increased reversibility of airflow
3. eosinophilic inflammation

Question 6

How is ACO syndrome managed?

Answer 6

1. Low Dose ICS → reduces inflammation in airways
2. Long-Acting Bronchodilator (LABA) → can help keep airways open
3. Long-Acting Muscarinic Agonist (LAMA)
4. Vaccinations