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8 Signs It's Not Just Asthma

Studies show that Black Americans are more prone to developing asthma and chronic obstructive pulmonary disease (COPD). While some of this increased risk can be linked to environmental factors, there is a genetic predisposition that doctors highlight as well. One subset of these people with respiratory conditions that aren't studied as often is Black people who have both conditions at the same time. According to one recent study, Black Americans have a higher likelihood of having asthma-COPD overlap syndrome (ACOS) but may not know it. Here's what you need to know about ACOS.

What is Asthma-COPD Overlap Syndrome (ACOS)?

Generally, doctors don't regard ACOS as a separate illness. Giving it a name is simply a way to acknowledge that you are dealing with the symptoms of two different chronic conditions at the same time. While the symptoms of asthma and COPD are similar, having them together can often result in more severe respiratory issues that have to be managed with a more intricate medical regimen. 

RELATED: Is It Asthma Or COPD? 5 Ways To Know The Difference

8 Signs You Have It 1. Constant Wheezing

Many people with asthma only wheeze when they're having a flare-up or have been exposed to a trigger. When you have COPD, the wheezing is a little more constant so if you're always wheezing you may have both. 

2. Difficulty Breathing

When you have asthma, you can expect to have difficulty breathing if you have a flare, you've been exposed to an irritant, or you're doing strenuous exercise when you have the type of asthma that's triggered by physical activity. On the other hand, difficulty breathing is a characteristic symptom of COPD.

3. Excess Mucus When Coughing

It's typical for asthmatic coughs to be dryer than the coughs you get from respiratory infections. However, people with COPD have an accumulation of mucus in their lungs that can result in wet, mucus-filled coughs.

4. Frequent Coughing

Depending on how severe your asthma is, you may go without coughing for a long time. When you're dealing with COPD, however, the cough is almost chronic.

5. Chronic Fatigue

This symptom is usually only experienced by people who have COPD. If you're dealing with asthma alone, you shouldn't have chronic fatigue.

6. Frequent Shortness of Breath

It's typical for shortness of breath to accompany an asthma flare or when you've done strenuous physical activity. You should be able to breathe normally if none of that is happening. If you have COPD, though, shortness of breath is something you have to deal with every day.

7. Tightness in the Chest

Again, this is a symptom that usually only happens when having an asthma flare. Once your body isn't responding to a trigger, you shouldn't have tightness in your chest. With COPD, this is an almost constant symptom.

8. Worsening Symptoms

One of the main things you'll notice if you have ACOS is that your symptoms tend to worsen regardless of what you do. That's because while asthma may stay the same as long as you manage it, COPD is a progressive condition. COPD is known to get worse over time so symptoms that used to be intermittent will become constant. At this point, your doctor will have to adjust your treatment.

RELATED: Asthma COPD: What you Need to Know Now

How The Condition is Treated

Your treatment for ACOS begins with getting a diagnosis. Given that the two conditions have similar symptoms, it's not always easy to diagnose. Your doctor will need detailed descriptions of your symptoms as well as the results of several tests. Some of the tests that you may undergo include X-rays, CT scans, or MRIs. You may also need a pulmonary function test that measures your lung function. Additionally, it can help your doctor decide if you point out how your symptoms respond to certain medications. 

Once you've been diagnosed, your doctor will look at the combination of medications that can help to alleviate your symptoms. Neither of these illnesses can be cured and COPD is progressive so your regimen may be adjusted over time to keep up with your worsening symptoms. 

Some of the medications you may be prescribed are low-dose inhaled corticosteroids (ICS), long-acting bronchodilators (LABA), and long-acting muscarinic antagonists (LAMA). An ICS will treat the inflammation in your airways while a LABA is meant to keep your airways open for up to 24 hours when combined with an anti-inflammatory. Finally, a LAMA is used to prevent your airways from tightening and making excess mucus. 

Along with medication, you may also need pulmonary rehabilitation to help with the COPD aspect of ACOS. This form of rehabilitation is meant to maintain your lung function and help to ensure that you have enough oxygen circulating through your body while doing daily activities. In time, you may also need oxygen therapy so that you'll have the necessary oxygen supply. 

Depending on how the condition progresses, you may need surgery to remove damaged lung tissue that's making your symptoms worse. 

RELATED: Improving Lung Function: 10 Things to Know About Pulmonary Rehab

How to Manage ACOS if You Have It

The most important part of managing ACOS is sticking to your medical regimen. Given the conditions that you're dealing with, it's important to manage them well. Your doctor will also ask that you identify and avoid common triggers like pollen, dust, chemical irritants, strong perfumes, smoke, and excessive physical activity. 

As stated previously, COPD is a progressive condition so your treatment will have to change to accommodate it. While using your medications, it's critical to let your doctor know if your symptoms aren't responding as well to certain medications. It can mean that you need a different dosage or it's time to move on to a more advanced level of treatment. 

Another aspect you need to pay attention to is getting the vaccines you need. Getting sick can worsen your symptoms and can even lead to a trip to the emergency room if things are severe. Doctors recommend getting influenza, pneumonia, COVID-19, and whooping cough vaccines, in particular, so you don't add a respiratory illness to everything you're already dealing with. Talk to your doctor to establish a schedule for these vaccines as you may not be able to get them all at once. 

Though more studies need to be done, it's possible that more Black Americans are dealing with ACOS than they know. The only way to be sure if you have it is to pay close attention to your symptoms and let your doctor know so you can be diagnosed.

Patients With Severe Asthma Benefit From Simple Psychoeducational Intervention

Photo Credit: Tumsasedgars

A psychoeducational intervention for extrapulmonary manifestations of severe asthma was found feasible and rated as beneficial by patients.

"When assessing the impact of management and treatment interventions aimed at improving HRQOL for those with severe asthma, it is important to look beyond the lung," researchers wrote in PEC Innovation. "The frequency and severity of extra-pulmonary symptoms in severe asthma are similar to those in patients diagnosed with syndromes of medically unexplained symptoms, such as fibromyalgia and chronic fatigue syndrome."

Joseph Lanario, PhD, and colleagues also noted that pulmonary rehabilitation, an evidenced-based education and exercise program for patients with COPD, has been found beneficial in addition to medication. Building on this and evidence from other respiratory diseases, the researchers hypothesized that an intervention designed to increase patients' knowledge of disease management, physical activity, relaxation, and other lifestyle changes that improve well-being and mood may also improve self-management and HRQOL for patients with severe asthma.

The study team conducted a feasibility study on the use of Body Reprogramming, a non-pharmacological, multi-component intervention originally developed for people with fibromyalgia, in patients with severe asthma to gauge its ability to improve the regulation of inflammatory mediators that contribute to extra-pulmonary symptoms.

The researchers assessed the benefits of the intervention using pre- and post-intervention asthma questionnaires and post-intervention interviews.

Feedback from Participants

The intervention enrolled 28 participants (mean age, 50; 93% women), and 12 of these patients participated in a post-course interview.

The post-course interviews identified four primary themes: time to reflect, interaction with others, pre-existing knowledge, and areas for improvement.

Time to Reflect

Participants noted that the small-group structure of the course, with content delivered from a trusted source, allowed them to reflect on their experience with severe asthma.

Other subthemes included:

Uncertainty about course design

Concerns about exercise requirements during sessions

Interest in learning more about asthma and comorbidities coupled with the inability to do so because of concerns about misinformation and anxiety

Viewing the course instructor as a trusted source

Interactions With Others

"Group interaction was viewed as a major benefit to partaking in [Body Reprogramming] for most participants," Dr. Lanario and colleagues wrote. "The lack of group discussion during the sessions was noticed by some that did comment. This was a source of disappointment and a viewed as a missed opportunity to involve patients who may have engaged more." 

Additional feedback provided under this theme included:

Mismatched experiences with severe asthma, leading to feedback from others being seen as "irrelevant" by some participants;

Discomfort with the group format;

Ability to ask questions and engage with the group; and

Ability to listen and observe others. 

Pre-Existing Knowledge

"Participants' pre-existing knowledge of their disease, symptom management, diet, and exercise framed how they experienced the course," the researchers wrote.

Additional feedback under this theme included:

Affirmation of techniques already used for managing health;

Importance of gentle movements and avoiding overexertion;

Comments that the course was better suited for newly diagnosed patients with no current methods for managing symptoms;

Course was too general;

Challenging preconceptions about health; and

New understanding of the relationship between eating habits and well-being.

 Areas for Improvement

"Group interaction was important to many participants," Dr. Lanario and colleagues wrote. "However, due to non-attendance of some participants, course sizes reduced over time. This was a source of disappointment." 

In addition to better attendance, other areas of improvement included:

Time for introductions during the first session;

More time for group discussions/questions and socializing; and

A session that addressed asthma medications

Directions for Future Studies

Based on the feedback, Dr. Lanario and colleagues outlined several areas to be addressed in future studies, focused primarily on research methods and the intervention parameters.

Strategies for addressing these included:

Stricter inclusion/exclusion criteria;

Use of 28 extrapulmonary symptoms as inclusion criteria;

Recruiting from multiple centers;

Increasing convenience and decreasing the burden of asthma questionnaires ;

Explanations of what the Body Reprogramming intervention does not involve; and

Optional group discussions at the end of sessions.

"An educational course focused on managing extra-pulmonary symptoms is feasible and of perceived benefit to patients with severe asthma," the researchers wrote. "[Body Reprogramming] could be incorporated into a rehab [program] for patients with severe asthma with significant extrapulmonary symptoms."

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