Asthma COPD overlap syndrome: clarifying the confusion

Here are key points from a recent article on this subject:

1) A patient with asthma may develop non-fully reversible airflow obstruction but this is not COPD, not even ACO; it is obstructive asthma.

2) A patient with asthma who smokes may also develop non-fully reversible airflow obstruction, which differs from obstructive asthma and from “pure” COPD. This is the most frequent type of patient with ACO.

3) Some patients who smoke and develop COPD may have a genetic Th2 background (even in the absence of a previous history of asthma) and can be identified by high eosinophil counts in peripheral blood. These individuals could be included under the umbrella term of ACO.

4) A patient with COPD and a positive bronchodilator test (greater than 200 mL and >12% FEV1 change) has reversible COPD but is not an asthmatic, or even ACO.

5) A patient with COPD and a very positive bronchodilator test (greater than 400 mL FEV1 change) is more likely to have some features of asthma and could also be classified as ACO.