Clinical Approach to the Therapy of Asthma-COPD Overlap

Abstract

Over the last few years, there has been a renewed interest in patients with characteristics of both asthma and COPD. Although the precise definition of asthma-COPD overlap (ACO) is still controversial, patients with overlapping features are frequently encountered in clinical practice, and may indeed have worse clinical outcomes and increased health-care utilization than those with asthma or COPD. Therefore, there is a critical need to set a framework for the therapeutic approach of such patients. There are key distinctions in the therapy between asthma and COPD, particularly regarding the initial choice of therapy. However, there is considerable overlap in the use of existing medications for both diseases. Furthermore, novel therapies approved for asthma, such as monoclonal antibodies, may have a role in patients with COPD and ACO. The use of biomarkers, such as peripheral blood eosinophils, exhaled nitric oxide, and serum IgE, may help in selecting appropriate therapies for ACO. In this review, we provide an overview of available treatments for both asthma and COPD and explore their potential role in the treatment of patients with ACO.

Keywords: COPD; asthma; overlap; therapy.

Figure 1

Treatment algorithm for chronic airway diseases. *Because of risk in patients with asthma with LABA monotherapy, ICS is the preferred therapy in ACO. **For patients with a chronic bronchitis phenotype and an FEV₁ < 50% predicted. #For patients with allergic asthma and high IgE levels or with peripheral eosinophilia. ACO = asthma-COPD overlap; ICS = inhaled corticosteroid; LABA = long-acting β₂ agonist; LAMA = long-acting muscarinic antagonist.