People who have symptoms of both asthma and chronic obstructive pulmonary disease (COPD) may have a condition known as asthma-COPD overlap syndrome (ACOS).

Asthma is a chronic lung disease that causes reversible airway narrowing, inflammation in the airways, and mucus production. Some asthma symptoms are shortness of breath, tightening in the chest, and wheezing.

Most people with asthma have exacerbations or flare-ups, which are times when their symptoms are worse than usual. There are also times when they have few or no symptoms.

Emphysema and chronic bronchitis are the two main conditions that fall under the COPD umbrella. COPD is a progressive disease that can cause shortness of breath, chest tightening, mucus production, and an ongoing cough. People with COPD have regular symptoms and also experience flares.

Asthma and COPD are the most commonly diagnosed chronic lung diseases. Both involve inflammation of the airways, obstruction of airflow, and other common symptoms. If you have symptoms of both of these conditions, you may have ACOS.

Symptoms of ACOS may include:

  • labored breathing
  • wheezing
  • wet or dry coughing
  • tightness in the chest

Symptoms can vary from day to day and typically include flare-ups. There are also key differences between the symptoms of asthma and COPD.

If you only have asthma, symptoms change often, and you may not have any symptoms at first.

Asthma often involves symptom triggers like exercise, exposure to allergens, or a respiratory illness. It can start in adulthood, but asthma usually begins in childhood. People with asthma often have allergies and eczema.

If you only have COPD, symptoms may start for some people who are 40 years and older. Symptoms can vary daily, but they’re chronic and progressive, even with treatment. Most people with COPD also have a history of smoking or smoke exposure.

ACOS shares characteristics of both COPD and asthma. People with ACOS experience some type of ongoing airway obstruction.

They also experience wheezing or breathing difficulties, which often respond to bronchodilators, which are medications that open the airway.

People with ACOS are often younger and experience more shortness of breath than people with COPD alone. However, because this condition is still being studied, experts do not yet agree on a single definition of the syndrome.

Because ACOS means you have both asthma and COPD, it’s important to look at each condition.

Researchers don’t know exactly why some people develop asthma. You might be more likely to have it if you:

  • have a family history of allergies or asthma
  • smoke or are regularly exposed to irritants such as tobacco smoke
  • have a personal history of allergies, especially if they developed in early childhood
  • had respiratory infections as a child

COPD is caused by long-term exposure to lung irritants. In the United States, the most common cause is cigarette smoke. Cigar smoke, pipe smoke, and secondhand smoke can cause COPD, too. So can chemical fumes, cooking fumes, and air pollution. Certain genetic mutations may make you more susceptible to COPD, but this is less common.

Having asthma doesn’t mean you’ll develop COPD. However, children with severe, persistent asthma may be more likely to develop COPD later in life.

ACOS has only recently been identified as a syndrome, so it’s not yet clear how many people are affected.

ACOS means you have symptoms of both asthma and COPD. Your doctor may diagnose asthma, COPD, or ACOS.

ACOS is a fairly new term. Exact guidelines for diagnosing ACOS haven’t been established. ACOS generally involves these three features when compared with people who have COPD alone:

  • more response to inhaled bronchodilators
  • increased reversibility of airflow
  • bronchial and systemic inflammation from eosinophils, a type of white blood cell

Your doctor will perform a physical examination and review your clinical history to reach a diagnosis. Imaging tests such as X-rays, CT scans, or MRI may be necessary. You’ll likely need a noninvasive test called spirometry, also known as a pulmonary function test, to measure your lung function.

Because asthma causes inflammation, you’ll still need asthma treatment. This may include:

  • avoiding allergens
  • allergy medications
  • inhaled corticosteroids
  • short-acting bronchodilators
  • long-acting bronchodilators
  • preventive vaccines, such as flu, pneumonia, COVID-19 and whooping cough

You’ll also need to manage symptoms of COPD to maintain lung function. This may involve:

  • disease management training
  • pulmonary rehabilitation
  • avoiding smoke and other pollutants
  • managing diet and nutrition
  • long-acting bronchodilator combinations or combination bronchodilator or inhaled corticosteroids
  • preventive vaccines, such as flu, pneumonia, COVID-19, and whooping cough
  • oxygen therapy
  • surgery to remove damaged lung tissue or air sacs (bullae)

Treatment for ACOS will be tailored to your symptoms and preferences. ACOS requires careful management and adherence to therapy. These are some of the people you might have on your healthcare team:

  • doctors
  • nurses
  • respiratory therapist
  • physical therapist or exercise expert
  • dietitian or nutritionist

After diagnosing ACOS, your doctor will instruct you on how best to manage your condition. Take medication as prescribed and follow up regularly.

Here are some other tips for managing ACOS:

  • Maintaining a balanced diet: Eating well can help you maintain your strength and improve your health. Ask your doctor if you have nutritional requirements and if you should take dietary supplements. Consider working with a dietitian or nutritionist.
  • Get vaccinated: Additional respiratory illnesses can become dangerous. Talk with your doctor about receiving vaccinations for influenza, pneumonia, COVID-19, and whooping cough to lower your risk of contracting these and other illnesses.
  • Avoid smoke and other pollutants: These can irritate your lungs and worsen symptoms.
  • Exercise: Physical activity is important for your health, but you don’t want to overdo it. Consult your doctor to determine what activities are safe for you. Ask your doctor about pulmonary rehabilitation and other exercise programs for people with lung disease.
  • Seek support: Whether it’s friends and family, psychological counseling, or a support group, it’s important to reach out for support. Also, make sure those closest to you know about your condition and what to do in an emergency. Check out the American Lung Association Better Breather’s Club for more information about support groups.

Your healthcare team can best advise you about any sudden worsening of symptoms, fever, or illness.

There’s no cure for ACOS. People with ACOS tend to have more hospitalizations and higher healthcare costs. It can also affect quality of life more than those who have only asthma or COPD.

ACOS is chronic and progressive, meaning symptoms can worsen over time. Treatment and disease management can help keep symptoms under control.

Your doctor can offer more detailed outlook information based on your age, symptoms, and overall health.

As far as researchers know, there is no way to prevent asthma, but you can lower your risk of developing COPD. It’s unclear if lowering your risk of COPD also lowers your risk of developing ACOS.

If you have asthma, you may be more susceptible to developing COPD if your asthma is severe and persistent. Managing your asthma is the best way to minimize the disease process. See your doctor regularly, avoid smoke and other lung irritants, and take prescribed medications as directed. Quitting smoking as soon as possible is key.

Smoking is the leading cause of COPD, and it makes asthma more difficult to manage. If you smoke and can’t quit smoking on your own, talk with your doctor about smoking cessation programs.

Find more help in preventing COPD and asthma

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You can experience symptoms of both asthma and COPD, which is known as asthma-COPD overlap syndrome (ACOS).

Given the overlap in symptoms and how they present in people, there isn’t an exact definition, and healthcare professionals don’t always diagnose it. Treatments may depend on the diagnosis and severity of the symptoms.