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Many common chronic diseases are clinically very heterogeneous with novel and genetically complex mechanisms that significantly interact with environmental forces. The chronic airway syndromes of asthma and chronic obstructive pulmonary disease (COPD) are excellent examples of such diseases where the environment, genetics and epigenetics contribute to a wide spectrum of phenotypes1,2,3,4. Asthma and COPD are both airway obstructive diseases and the two most common respiratory diseases worldwide with millions of patients suffering from these syndromes1. Because these both are so common, probability would suggest that there would be patients that could have both diseases or at least elements of both syndromes. In 2004, Guerra noted that it was common in clinical practice to see patients with asthma that also showed COPD-like phenotypes and vice versa5. The overlap of asthma and COPD in adults was also suggested by the observation than adult patients with active asthma were 12 times more likely to acquire COPD over time than patients without active asthma5. Gibson and Simpson noted in 2009 that epidemiological studies have shown as many as half of the older patients with obstructive airway disease have overlapping diagnoses of both asthma and COPD6. They named this the “overlap syndrome”.

Why understanding the asthma chronic obstructive pulmonary disease overlap syndrome (ACOS) is important to the clinician