On March 15, the U.S. Food and Drug Administration (FDA) approved the first over-the-counter inhaler designed to help treat both chronic obstructive pulmonary disease (COPD) and asthma for patients ages 6 years and older. While COPD and asthma are both known to have a negative impact on the cardiovascular system, when both appear at the same time, risk increases. A National Center for Biotechnology Information (NCBI) report of a 5.7-year study concluded in 2020 stated that the combined presence of COPD and asthma, referred to as asthma-COPD overlap syndrome (ACOS), resulted in increased occurrences of coronary heart disease and heart failure. The study also states that the probability of cardiovascular problems among allergy patients is exacerbated by the presence of allergies.

COPD includes several conditions that create chronic lung problems. The two most common conditions found in COPD are emphysema and chronic bronchitis. According to the American Lung Association (ALA), by 2018, nine million adult Americans, or 3.6% of the population over age 18, had chronic bronchitis. In the same year, two million adults, or 1.6%, were diagnosed with emphysema. Both conditions appear more often in those ages 65 and older and among non-Hispanic Caucasians. However, chronic bronchitis appears more often among women while emphysema occurs more frequently in the male population. It should be noted that while emphysema still appears more frequently in men, the rate has increased among women during the past 20 years.

By 2020, 16 million Americans were living with some form of COPD, including chronic bronchitis, asthma and other conditions that fall under that classification. There are several stages of COPD ranging from mild to moderate or severe to very severe.


Asthma can both narrow the body’s airways and make them swell. Excess mucus may also be produced and it may appear mild or severe. Extremely severe life-threatening attacks can take place. Mayo Clinic reports that symptoms can be triggered by exercise, allergies and other factors. As of 2020, 8.4% of Americans ages 18 and older have asthma while 5.8% of diagnoses have appeared in children in the U.S. Annually, 4,145 deaths are attributed to asthma, according to the Centers for Disease Control and Prevention (CDC).  That translates to an estimated 25 million Americans live with asthma, with over 5 million of being children.

Asthma-COPD overlap syndrome (ACOS)

ACOS is not classified as a disease. It is the condition that occurs when symptoms of asthma and COPD appear simultaneously. Both asthma and COPD make breathing more difficult and there are also similar symptoms of ACOS. They include fatigue, wheezing, the presence of more mucus and shortness of breath. ALA reports that persistent airflow reduction, a common symptom of COPD, and specific features of asthma must both be present for ACOS to be diagnosed. The use of a metered-dose inhaler, such as the one approved for generic sales by FDA, is among the ways to treat ACOS. The inhalers, and other treatment methods, are designed to help keep airways open.

Diagnosis and treatment

When symptoms of ACOS begin to appear, several diagnostic methods can be employed. Among them are examinations of the age of the person at the time symptoms began to appear. Additionally, family history involving COPD, asthma or ACOS, as well as a history of symptom occurrence, exposure to lung irritants and smoking may also be reviewed. Chest x-rays and the examination of lung function also help determine the presence of ACOS.

If ACOS is diagnosed several types of medicine can be prescribed and administered in different ways. Among them are a low-dose inhaled corticosteroid (ICS). This treatment for inflammation in the airways is often prescribed for asthma. A device designed to keep airways open longer is a long-acting bronchodilator (LABA). ALA states that this device should be combined with anti-inflammatory medication. Another medicine often used in COPD treatment that helps reduce mucus production and airway restriction may also be prescribed. This is called a long-acting muscarinic agonist (LAMA).

According to the American College of Allergy, Asthma and Immunology (ACAAI), treatment for each individual diagnosed with ACOS will vary. In addition to the methods listed above, supplemental oxygen and lung rehabilitation may be necessary. A physician should be notified immediately if symptoms appear.

To learn more about a variety of health conditions, management and treatment, log on to vascularhealthclinics.org.

Do you have questions about your heart health? Ask Dr. Haqqani.

If you have questions about your cardiovascular health, including heart, blood pressure, stroke lifestyle and other issues, we want to answer them. Please submit your questions to Dr. Haqqani by e-mail at [email protected] .

Omar P. Haqqani is the Chief of Vascular and Endovascular Surgery at Vascular Health Clinics in Midland.

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