Can Chronic Obstructive Pulmonary Disease (COPD) be caused by asthma?

From the Guidelines

Asthma can contribute to the development of Chronic Obstructive Pulmonary Disease (COPD), particularly in cases of poorly controlled asthma, as it can lead to airflow obstruction that meets the spirometric criteria for COPD. According to a recent study published in Thorax in 2023 1, asthma was found to be strongly associated with the development of COPD, with patients with asthma having a 12-fold higher risk of developing COPD compared to those without asthma. This highlights the importance of proper management of asthma to prevent the development of fixed airflow obstruction.

Key Points to Consider

• Asthma itself does not typically cause COPD, but there is a complex relationship between the two conditions, with some people with long-standing, poorly controlled asthma developing fixed airflow obstruction that resembles COPD, a condition sometimes called asthma-COPD overlap syndrome (ACOS) 1.
• The key difference between asthma and COPD is that asthma typically features reversible airflow limitation, while COPD involves progressive, largely irreversible airflow limitation.
• Other causes of COPD include long-term exposure to lung irritants such as cigarette smoking, air pollution, workplace dust, chemicals, and genetic factors like alpha-1 antitrypsin deficiency.
• Proper management of asthma with controller medications like inhaled corticosteroids, avoiding triggers, and regular medical follow-up can help prevent the development of fixed airflow obstruction and minimize the risk of permanent lung damage over time.

Recommendations for Patients with Asthma

• Work with your healthcare provider to maintain good control of your symptoms and minimize the risk of permanent lung damage over time.
• Use controller medications like inhaled corticosteroids as prescribed by your healthcare provider.
• Avoid triggers and follow a regular medical follow-up schedule to monitor your condition and adjust your treatment plan as needed.

From the Research

COPD and Asthma Relationship

• Asthma and Chronic Obstructive Pulmonary Disease (COPD) are both defined by the presence of airflow obstruction, but they present distinguishing differences in terms of both risk factors and clinical phenotypes 2.
• Adult subjects with active asthma are as much as 12 times more likely to acquire COPD over time than subjects with no active asthma 2.

Asthma-COPD Overlap Syndrome

• There is a group of patients with an overlap between clinical, functional characteristics and airway inflammation patterns, named "Asthma-COPD Overlap Syndrome" (ACOS) 3.
• ACOS is a syndrome characterized by reversible but persistent airflow limitation which has some features of both asthma and COPD 3.
• Patients with ACOS are younger than COPD patients and older than asthma patients, and they experience frequent and severe exacerbations and related hospitalization and emergency room visits 3, 4.

Pathogenesis and Clinical Features

• The pathogenesis of ACOS is not yet fully understood, but it is thought to involve gradual shifts in airway remodelling and inflammation in a patient with COPD or as the result of noxious exposures in a patient with asthma 4.
• Patients with ACOS have significantly worse respiratory symptoms, poorer quality of life, and increased risk of exacerbations and hospital admissions compared to their counterparts with asthma or COPD alone 4.

Therapeutic Targets

• Using treatments developed for asthma or COPD that target eosinophilic, neutrophilic, or paucigranulocytic airway inflammation may be a helpful approach to patients with ACOS until further clinical trials can be performed 4.
• Current recommendations of guidelines for pharmacologic treatment of ACOS have been composed of a combination with optimal COPD and asthma treatment 3.