What Happens If I Have Asthma and COPD Together? Explained

Yes, you can have both asthma and COPD at the same time. While doctors previously called this “Asthma-COPD Overlap Syndrome” (ACOS), current medical guidelines treat them as two distinct conditions that can coexist ^[1]. If you have both, it changes how your daily medications are prescribed to ensure both conditions are managed safely ^[1].

Overlapping Symptoms: Asthma vs. COPD

Asthma and COPD both make it difficult to breathe, but they usually have different patterns:

• Asthma typically features variable symptoms that come and go. Flare-ups are often triggered by allergies (a tendency toward allergic disease called atopy), exercise, or viral infections ^[2]. While it often begins in childhood, it can start in adulthood.
• COPD (Chronic Obstructive Pulmonary Disease) typically causes persistent, daily symptoms ^[2]. It is usually an adult-onset condition linked to long-term exposure to cigarette smoke, biomass fumes, or occupational hazards, though it can occasionally affect non-smokers.

The lines between the two can blur. Some patients with longstanding, severe asthma develop persistent airflow limitation that does not fully reverse, looking very similar to COPD ^[3]. Conversely, some patients with COPD can develop asthma-like features, such as increased allergies ^[4].

The Challenge of Diagnosis

Because symptoms overlap, there is no single blood test that diagnoses both conditions. Doctors use lung function tests, your medical history, and lab work to build a complete picture.

Breathing Tests (Spirometry)

During a lung function test, your doctor will check your bronchodilator reversibility. This involves measuring your breathing, giving you a quick-relief (rescue) inhaler to quickly open your airways, and measuring again.

While this test is helpful, a “positive” response (meaning the airways open up significantly) cannot reliably separate asthma from COPD on its own ^[5]. Many patients with pure COPD also show a positive response, so this result must be interpreted alongside your full evaluation ^[5].

Supportive Biomarkers: Eosinophils and FeNO

Doctors may also look at biomarkers (measurable indicators in your body) for signs of asthma-like inflammation:

• Eosinophils: A type of white blood cell involved in allergic reactions. Higher levels can suggest an asthma component and help doctors estimate whether you might benefit from corticosteroid inhalers ^[6].
• FeNO (Fractional exhaled nitric oxide): A breathing test measuring a gas produced by inflamed airways. High levels can point toward asthma-like inflammation ^[7].

These tests provide clues, but they are not definitive proof of asthma. Their results can be altered by current steroid treatments, infections, and allergies, and smoking can artificially lower FeNO levels ^[8][9].

How Coexisting Asthma Changes Your Treatment

The most critical reason to know if you have both conditions is inhaler safety. You should never stop, add, or switch inhalers without consulting your prescriber, but understanding the safety principles can help you have an informed discussion with your care team.

The Danger of LABA Monotherapy

For people who have COPD without asthma, doctors frequently prescribe a LABA (Long-Acting Beta-Agonist) or a LAMA (Long-Acting Muscarinic Antagonist) by themselves to keep the airways open. This is called monotherapy.

However, using a LABA inhaler without an ICS (Inhaled Corticosteroid) is dangerous for people with asthma ^[10]. Therefore, if asthma is confirmed or strongly suspected alongside your COPD, medical guidelines dictate that you should avoid LABA monotherapy ^[11].

ICS-Containing Regimens

If you have both conditions, your clinician will generally ensure that an ICS is included in your daily treatment plan ^[11]. The ICS reduces the specific type of airway inflammation caused by asthma, which helps lower the risk of severe flare-ups ^[12].

Depending on your symptoms, your doctor might prescribe an ICS and LABA combination inhaler, and they may add a LAMA (known as triple therapy) if you continue to have exacerbations ^[13][14].

Note on ICS Safety: Inhaled corticosteroids carry risks, including a higher chance of developing pneumonia in some COPD patients, as well as oral thrush and hoarseness ^[15]. Always rinse your mouth with water and spit after using an ICS controller inhaler to reduce mouth side effects.

Lifestyle and Prevention

Medications work best when paired with healthy habits. Avoiding respiratory triggers, getting support to quit smoking, reducing exposure to occupational dust, and staying up to date on your vaccines are cornerstone measures for preventing dangerous exacerbations ^[13]. Pulmonary rehabilitation or guided physical activity can also be highly beneficial once your symptoms are controlled.

When to Seek Emergency Care

Breathing flare-ups can escalate quickly. Seek immediate emergency medical help (call 911 or your local emergency number) if you experience:

• Severe breathlessness at rest or an inability to speak in full sentences
• Lips or fingertips turning blue or gray
• Confusion, severe drowsiness, or dizziness
• Severe chest pain
• Little or no relief from using your quick-relief (rescue) inhaler

Ask your doctor to help you create a written action plan so you know exactly what to do when your symptoms worsen.