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19 Oct 2023 • Here's the dilemma🤷‍♀️

Is it Asthma or COPD?

A 60-year-old male presents to the ER with complaints of fever and cough with expectoration for past 2 weeks and difficulty in breathing for past 2 days😷

He reports a history of breathlessness since childhood from 15-years of age.

The patient also gives a history of seasonal variation of SOB on exposure to dust which is more during winters often requiring hospitalisation.

He has been smoking for the past 35 years with more than 10 pack years.🚬

On examination🧐

  • Patient is dyspnoeic
  • Vitals: BP of 132/90, HR of 110/min, RR of 32/min, SpO2 of 86% on room air.
  • Pallor and clubbing is present
  • 🩺Auscultation: Bilateral rhonchi with decreased breath sounds on infra-scapular areas

🔎Lab investigations were unremarkable except for a WBC of 14600 cells/L, Haemoglobin of 13.3 g/dl, ESR of 20 mm/hr and AEC of 628 cells/mcL.


  • FEV1: 46%, Post Bronchodilator FEV1: 53%
  • FEV1/FVC: 56%, Post Bronchodilator FEV1/FVC: 56%
  • Post Bronchodilator increase in FEV1 is 21%.

So, is it Asthma or COPD?🤷‍♂️

No! Its neither!🤦‍♂️

It is Asthma - COPD Overlap Syndrome!

The GINA Guidelines say the following about ACOS💁‍♂️

  • There is no accepted definition
  • Patients are usually >40 years of age
  • History of asthma at a younger age
  • Reported partial bronchodilator reversibility
  • Exposure to a risk factor (e.g. ≥10 years of smoking, indoor/outdoor air pollution

Our patient satisfies all the criteria in the above checklist.✅

So how do we treat ACOS?

Along with non-pharmacologic therapies like smoking cessation and pulmonary rehabilitation, these patients can benefit from ICS in low to moderate doses.

If needed, a LAMA or LABA may be added.

What about our patient? How do we treat him?🧐

He had persistent symptoms, hence he was started on a triple therapy of ICS, LAMA and LABA👩🏻‍⚕

What if his symptoms still persist?

We can always consider other therapies like biologic agents!

Want to know more about ACOS? Tune in now!🤗

🔗Click here to watch the session on Asthma and COPD Overlap by Dr. Nidhi Kaeley right here on Medflix💛

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