GPAtlas🧭 When to suspect
Asthma–COPD overlap (ACO) describes a patient with persistent airflow obstruction who has clinical features of both asthma and COPD.
• ACO is best understood as a descriptive label, not a single disease.
• Global Initiative for Asthma (GINA) now prefers the term “asthma + COPD” precisely because “overlap” was so often wrongly assumed to represent one discrete condition.
• These patients carry a greater burden of symptoms and exacerbations, faster lung-function decline and higher mortality than either asthma or COPD alone.
Suspect ACO in a patient, typically over 40 with a smoking or exposure history, presenting in one of two patterns:
• An adult with a personal or family history of asthma or atopy who develops persistent, progressive breathlessness.
• Someone carried as COPD who shows marked day-to-day variability, a large bronchodilator response, raised eosinophils or nocturnal symptoms.
Recognise the asthma component (because it changes treatment and safety entirely), and never miss an alternative diagnosis such as lung cancer, bronchiectasis or heart failure.
| Features pointing to the asthma component |
|---|
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• Symptoms under age 35, or a secure previous asthma diagnosis |
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• Variable symptoms – day-to-day, seasonal, or with triggers (allergen, exercise, cold air) |
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• Nocturnal waking with cough or wheeze; atopy (eczema, rhinitis) |
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• Large reversibility, raised eosinophils or raised FeNO (steroid-responsive markers) |
| Features pointing to the COPD component |
|---|
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• Current or ex-smoker (or significant dust/fume/biomass exposure) |
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• Persistent, progressive breathlessness rather than variable |
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• Chronic productive cough, especially in the mornings |
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• Fixed obstruction with little day-to-day variability |
Source: NICE NG115 · NICE NG245 · GINA 2025
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