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Is biologic therapy effective for asthma-COPD overlap?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hello doctor,

I am 60 years old and have severe asthma that overlaps with COPD, likely due to years of smoking. I am currently on triple inhaler therapy, but I still experience flare-ups, especially when I get infections. My pulmonologist mentioned the possibility of using biologic therapy for eosinophilic asthma. I would like to know how we test to determine if I qualify for biologics and whether this treatment could also help manage the COPD aspect of my condition. I also use supplemental oxygen occasionally at night.

Please help.

Thank you.

Answered by Dr. Fizza Noor

Hello,

Welcome to icliniq.com.

I understand your concern.

Thank you for your detailed query. It is common for patients with asthma-COPD (chronic obstructive pulmonary disease) overlap (ACO) to experience persistent symptoms despite triple inhaler therapy. Let us address your concerns:

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.

The Probable causes

Chronic inflammation associated with asthma and COPD. Eosinophilic airway disease Environmental triggers or recent infections.

Investigations to be done

Peripheral blood eosinophil count. Total IgE level and specific allergen panel (optional), and FeNO (fractional exhaled nitric oxide) (if available). Pulmonary function test with bronchodilator response. Chest X-ray or HRCT (high-resolution computed tomography) if not done recently.

Differential diagnosis

Uncontrolled eosinophilic asthma COPD with frequent exacerbator phenotype bronchiectasis (to be ruled out).

Probable diagnosis

Asthma-COPD overlap syndrome (ACOS) with eosinophilic inflammation.

Treatment plan

Continue triple inhaler therapy (ICS + LABA + LAMA). Add biologic therapy if eosinophil criteria are met. Continue night-time oxygen as prescribed. Pulmonary rehabilitation and breathing exercises. Smoking cessation support (if applicable).

Preventive measures

Re-check eosinophil levels after three months of biologics. Pulmonology follow-up every three to six months. Assess exacerbation frequency and oxygen requirement. Preventive measures: Annual flu shot and pneumococcal vaccination. Avoid allergens, pollution, and respiratory infections. Use spacer devices with inhalers to improve drug delivery.

Regarding follow up

Re-check eosinophil levels after 3 months of biologics Pulmonology follow-up every 3–6 months Assess exacerbation frequency and oxygen requirement

Answered byDr. Fizza Noor

Medically reviewed byiCliniq medical review team

Published At September 1, 2025
Reviewed AtSeptember 1, 2025

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Fizza Noor
Dr. Fizza Noor

Pediatric Allergy/Asthma Specialist

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