Patients with COPD often give histories that suggest a previous asthmatic diagnosis that was never made. Unfortunately for these patients, they have significant amounts of airflow obstruction due to a history of smoking or poor, if any, treatment for unrecognized asthma.
Treatment for these patients, up until recently, was basically the same. These patients were treated with bronchodilator therapy along with inhaled corticosteroids. They, of course, were encouraged to stop smoking but frequently did not and were frequent visitors to the local emergency rooms for exacerbations.
Recently, we are recognizing that many of these patients have what has been called the Asthma-COPD Overlap Syndrome or ACO. The reason this is now a more important distinction to make is because there are additional therapies that may help these patients.
The development of biologic therapies for patients with asthma are now being considered for add-on therapy in patients with ACO Syndrome. Part of the problem is that these patients are not always easy to recognize. Usually, patients with ACO have more reversible airway obstruction on pulmonary function testing. In order to qualify for specific biologic therapies, they must demonstrate specific findings on certain blood tests. The biologic therapies are usually injectable, rather that pills or inhalers, and must be given at least once a month. As you might suspect there is also a cost factor and the need for insurance approval.
National experts on asthma are suggesting screening our COPD patients to determine if they may be candidates for biologic therapy.