Therapeutic approaches to asthma-chronic obstructive pulmonary disease overlap

Patients with features of both asthma and chronic obstructive pulmonary disease (COPD) ('asthma-COPD overlap') experience greater symptom burden and higher risk of adverse health outcomes than those with asthma or COPD alone. However, virtually no pharmacotherapy studies have been performed in this overlap population, leading to confusion amongst clinicians regarding therapeutic approaches. Areas covered: A pragmatic approach is suggested to identify patients with typical asthma, typical COPD, and those with overlap features. Interim clinical guidance on the treatment of asthma-COPD overlap is provided, acknowledging that these recommendations are based on expert opinion given the paucity of available evidence. Expert commentary: There is an urgent need for new studies in patients with asthma-COPD overlap to evaluate the efficacy and safety of existing pharmacotherapeutic options. Multiple underlying mechanisms are likely to contribute to the development of asthma-COPD overlap and a greater understanding of these mechanisms may allow a personalised approach to therapy in the future.