The condition known as asthma–COPD overlap (ACO) presents a complex clinical spectrum demanding evolving management strategies that align bronchodilator therapy, anti-inflammatory control, and emerging biological interventions.
Clinicians often grapple with patients whose symptoms defy classic COPD paradigms, exhibiting both fixed obstruction and airway hyperresponsiveness. Insights from a real-world study in the prospective RealDTC cohort indicate that tailored inhalation therapies for asthma-like COPD features improve specific outcomes such as FEV1 and exacerbation rates, with statistically significant effect sizes reported.
Accurate differentiation between COPD, asthma, and asthma–COPD overlap (ACO) underpins effective treatment, consistently using the term asthma–COPD overlap (ACO) to describe overlapping presentations. According to the GOLD guidelines, bronchodilator responsiveness is an essential diagnostic tool for assessing reversibility and guiding treatment pathways in COPD and asthma. A key analysis focused on differentiating asthma, COPD, and ACO demonstrated that structured reversibility testing reduces misclassification, guiding clinicians toward anti-inflammatory versus bronchodilator-first strategies.
Addressing oxidative stress represents another frontier. Mesenchymal stem cells propose a potential mechanism to modulate redox balance via the Nrf2 pathway, with current evidence mainly from preclinical or early-phase trials. Research on MSCs to regulate oxidative stress through the Nrf2 pathway is largely in early-phase trials, and while promising, these interventions are not yet ready to complement standard COPD inhalation therapies in clinical practice.
Integrating these advances into daily practice will require robust patient stratification, expanded access to diagnostic reversibility testing, and collaboration across pulmonology and regenerative medicine. As delivery platforms mature and more real-world data become available, personalized algorithms for patients on the asthma-COPD spectrum can enhance both symptom control and long-term outcomes.
Key Takeaways:- Inhalation therapies for asthma-like COPD require personalization of device and drug to patient phenotype, as evidenced by real-world studies.
- Bronchodilator responsiveness is essential for differentiating asthma, COPD, and ACO, enabling more precise therapeutic choices.
- Emerging biological treatments, such as mesenchymal stem cells via the Nrf2 pathway, represent promising avenues to mitigate oxidative stress in COPD.