{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T10:18:16Z","timestamp":1788171496390,"version":"build-2803163510"},"reference-count":40,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Adv. Respir. Med.","ARM"],"abstract":"<jats:p>Background: The asthma\u2013COPD overlap is widely recognized, but its characteristics are not fully understood. This is largely true for the clinical presentation characterized by various ACO definitions. The purpose of this study was to investigate the pattern of comorbidities among patients with ACO, defined by various criteria. Methods: The data came from the multicenter cross-sectional study conducted in a mixed population of patients with asthma and COPD. Patients were classified into five groups according to five different definitions of ACO (GINA\/GOLD\/30%, Spanish criteria, COPD + asthma &lt; 40, Gibson\u2019s criteria, clinician\u2019s diagnosis), reference ACO groups, and a group of patients with obstructive pulmonary diseases who were not diagnosed with ACO. To demonstrate the differences between groups, we compared the prevalence of comorbidities between all ACO and non-ACO groups. Data on age, severity of airflow obstruction, and smoking history were recorded for all patients. Results: For the final analysis, 1609 patients were included. Patients belonging to the ACO groups had a higher burden of comorbidities, poorer lung function, and a higher number of pack-years of smoking history compared to patients without an ACO diagnosis. Comorbidities were significantly more prevalent in ACO groups. Compared to the non-ACO group, nine diseases were more common in the GINA\/GOLD\/30% group, seven in both the COPD + asthma &lt; 40 group and the clinician\u2019s diagnosis group, five in the Gibson\u2019s criteria group, and two in the Spanish criteria group. The most common comorbidities in the ACO groups were hypertension, coronary artery disease, GERD, musculoskeletal disorders, diabetes, and chronic sinusitis. Chronic sinusitis was more frequent in ACO groups defined by more precise asthma criteria. Conclusions: The definitions of ACO used in clinical practice vary widely and describe different populations. ACO populations vary in terms of comorbidities, lung function, smoking history, and age. Chronic sinusitis is a comorbidity that occurs more frequently in ACO groups defined by more precise asthma criteria. Patients with ACO differ in their clinical outcomes from those with other obstructive airway diseases.<\/jats:p>","DOI":"10.3390\/arm94050062","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T09:21:19Z","timestamp":1788168079000},"page":"62","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patterns of Comorbidity in Asthma\u2013COPD Overlap Cohort According to Various ACO Definitions"],"prefix":"10.3390","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7611-6198","authenticated-orcid":false,"given":"Andrzej","family":"Obojski","sequence":"first","affiliation":[{"name":"Department of Allergology and Internal Medicine, Faculty of Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3205-3647","authenticated-orcid":false,"given":"Krzysztof","family":"Kuziemski","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Collegium Medicum, University of Warmia and Mazury, 10-357 Olsztyn, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9106-8355","authenticated-orcid":false,"given":"Marek","family":"Barczyk","sequence":"additional","affiliation":[{"name":"Department of Computer Networks and Systems, Silesian University of Technology, 44-100 Gliwice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"project-administration","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0087-2031","authenticated-orcid":false,"given":"Rafa\u0142","family":"Krenke","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Pulmonary Diseases & Allergy, Medical University of Warsaw, 02-097 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewa","family":"Wycinka","sequence":"additional","affiliation":[{"name":"Department of Statistics, Faculty of Management, University of Gdansk, 81-824 Sopot, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6567-9208","authenticated-orcid":false,"given":"Adam","family":"Barczyk","sequence":"additional","affiliation":[{"name":"Department of Pneumonology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-635 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"ref_1","unstructured":"Global Initiative for Asthma (2024, April 25). Global Strategy for Asthma Management and Prevention 2022. Available online: www.ginasthma.org."},{"key":"ref_2","unstructured":"Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2025, April 14). 2022 Global Strategy for Prevention, Diagnosis and Management of COPD. Available online: https:\/\/goldcopd.org\/2022-gold-reports\/."},{"key":"ref_3","unstructured":"(2025, April 14). Diagnosis of Diseases of Chronic Airflow limitation: Asthma, COPD and Asthma-COPD Overlap Syndrome (ACOS) 2015. Available online: https:\/\/goldcopd.org\/asthma-copd-asthma-copd-overlap-syndrome\/."},{"key":"ref_4","first-page":"S146","article-title":"Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS): Current literature review","volume":"6","author":"Papaiwannou","year":"2014","journal-title":"J. Thorac. Dis."},{"key":"ref_5","first-page":"S77","article-title":"Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease","volume":"152","author":"Celli","year":"1995","journal-title":"Am. Thorac. Soc. Am. J. Respir. Crit. Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1378\/chest.13-0622","article-title":"Increased risk of exacerbation and hospitalization in subjects with an overlap phenotype: COPD-asthma","volume":"145","author":"Menezes","year":"2014","journal-title":"Chest"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1186\/1465-9921-12-127","article-title":"The clinical features of the overlap between COPD and asthma","volume":"12","author":"Hardin","year":"2011","journal-title":"Respir. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"163","DOI":"10.3109\/15412555.2013.831061","article-title":"Medical Utilization and Cost in Patients with Overlap Syndrome of Chronic Obstructive Pulmonary Disease and Asthma","volume":"11","author":"Rhee","year":"2014","journal-title":"COPD"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2326","DOI":"10.1016\/j.jaip.2019.04.022","article-title":"Asthma-COPD Overlap-A Discordance Between Patient Populations Defined by Different Diagnostic Criteria","volume":"7","author":"Barczyk","year":"2019","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.arbr.2012.06.017","article-title":"Consensus document on the overlap phenotype COPD-asthma in COPD","volume":"48","author":"Cosio","year":"2012","journal-title":"Arch. Bronconeumol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1016\/j.rmed.2013.03.007","article-title":"Characterisation of the overlap COPD-asthma phenotype. Focus on physical activity and health status","volume":"107","author":"Miravitlles","year":"2013","journal-title":"Respir. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/j.rmed.2013.01.001","article-title":"Prevalence and characteristics of three clinical phenotypes of chronic obstructive pulmonary disease (COPD)","volume":"107","author":"Unzueta","year":"2013","journal-title":"Respir. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1136\/thx.2008.108027","article-title":"The overlap syndrome of asthma and COPD: What are its features and how important is it?","volume":"64","author":"Gibson","year":"2009","journal-title":"Thorax"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1183\/09031936.00080312","article-title":"Multi-ethnic reference values for spirometry for the 3\u201395-yr age range: The global lung function 2012 equations","volume":"40","author":"Quanjer","year":"2012","journal-title":"Eur. Respir. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/00001648-199001000-00010","article-title":"No Adjustments Are Needed for Multiple Comparisons","volume":"1","author":"Rothman","year":"1990","journal-title":"Epidemiology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e000783","DOI":"10.1136\/bmjmed-2023-000783","article-title":"To adjust or not to adjust: It is not the tests performed that count, but how they are reported and interpreted","volume":"3","author":"Boulesteix","year":"2024","journal-title":"BMJ Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"390","DOI":"10.21037\/atm-20-4576","article-title":"Pulmonary tuberculosis as a risk factor for chronic obstructive pulmonary disease: A systematic review and meta-analysis","volume":"9","author":"Fan","year":"2021","journal-title":"Ann. Transl. Med."},{"key":"ref_18","unstructured":"Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2025, April 14). Global Strategy For Prevention, Diagnosis And Management of COPD: 2024 Report. Available online: https:\/\/goldcopd.org\/2024-gold-report\/."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1159\/000326899","article-title":"Anemia of Chronic Disease in Chronic Obstructive Pulmonary Disease: A Case-Control Study of Cardiopulmonary Exercise Responses","volume":"82","author":"Boutou","year":"2011","journal-title":"Respiration"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"452","DOI":"10.4236\/ijcm.2014.58063","article-title":"Prevalence of Anemia in Patients with COPD and Its Potential Impact on Morbidity of COPD Patients","volume":"5","author":"Parveen","year":"2014","journal-title":"Int. J. Clin. Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Silverberg, D.S., Mor, R., Weu, M.T., Schwartz, D., Schwartz, I.F., and Chernin, G. (2014). Anemia and iron deficiency in COPD patients: Prevalence and the effects of correction of the anemia with erythropoiesis stimulating agents and intravenous iron. BMC Pulm. Med., 14.","DOI":"10.1186\/1471-2466-14-24"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e024350","DOI":"10.1161\/JAHA.121.024350","article-title":"Time-Dependent Risk of Cardiovascular Events Following an Exacerbation in Patients With Chronic Obstructive Pulmonary Disease: Post Hoc Analysis From the IMPACT Trial","volume":"11","author":"Dransfield","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/j.chest.2020.02.046","article-title":"Mortality of Cardiovascular Events in Patients With COPD and Preceding Hospitalization for Acute Exacerbation","volume":"158","author":"Wang","year":"2020","journal-title":"Chest"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1164\/rccm.201602-0419OC","article-title":"Inflammatory and Comorbid Features of Patients with Severe Asthma and Frequent Exacerbations","volume":"195","author":"Denlinger","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1111\/resp.12420","article-title":"Gastro-esophageal reflux disease and exacerbations in chronic obstructive pulmonary disease","volume":"20","author":"Ingebrigtsen","year":"2015","journal-title":"Respirology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1183\/09031936.05.00037905","article-title":"Risk factors of frequent exacerbations in difficult-to-treat asthma","volume":"26","author":"Brinke","year":"2005","journal-title":"Eur. Respir. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1067\/mai.2002.123237","article-title":"Intranasal steroids and the risk of emergency department visits for asthma","volume":"109","author":"Adams","year":"2002","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1016\/S0140-6736(08)61446-4","article-title":"Rhinitis and onset of asthma: A longitudinal population-based study","volume":"372","author":"Shaaban","year":"2008","journal-title":"Lancet"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/j.1398-9995.1997.tb04818.x","article-title":"The link between the nose and lung, perennial rhinitis and asthma\u2014Is it the same disease?","volume":"52","year":"1997","journal-title":"Allergy"},{"key":"ref_30","first-page":"7","article-title":"The nose-lung interaction in allergic rhinitis and asthma: United airways disease","volume":"1","author":"Passalacqua","year":"2001","journal-title":"Curr. Opin. Allergy Clin. Immunol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1183\/09031936.01.17405960","article-title":"Prevalence of nasal symptoms and their relation to self-reported asthma and chronic bronchitis\/emphysema","volume":"17","author":"Svensson","year":"2001","journal-title":"Eur. Respir. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/S0954-6111(03)00114-8","article-title":"Relationship between chronic nasal and respiratory symptoms in patients with COPD","volume":"97","author":"Roberts","year":"2003","journal-title":"Respir. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1183\/09031936.00119712","article-title":"Sinonasal inflammation in COPD: A systematic review","volume":"42","author":"Konge","year":"2013","journal-title":"Eur. Respir. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1111\/j.1475-097X.2006.00683.x","article-title":"Nasal symptoms, airway obstruction and disease severity in chronic obstructive pulmonary disease","volume":"26","author":"Hurst","year":"2006","journal-title":"Clin. Physiol. Funct. Imaging"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2025","DOI":"10.2147\/COPD.S165857","article-title":"Clinical impact of nasal budesonide treatment on COPD patients with coexistent rhinitis","volume":"13","author":"Calabrese","year":"2018","journal-title":"Int. J. COPD"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1164\/rccm.201204-0596PP","article-title":"Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary","volume":"187","author":"Vestbo","year":"2013","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_37","unstructured":"Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2025, July 20). 2020 Global Strategy for Prevention, Diagnosis and Management of COPD. Available online: https:\/\/goldcopd.org\/gold-reports\/."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1513\/AnnalsATS.201508-554OC","article-title":"Characteristics and Prevalence of Asthma\/Chronic Obstructive Pulmonary Disease Overlap in the United States","volume":"13","author":"Kumbhare","year":"2016","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/j.chest.2015.12.002","article-title":"Comorbidome, Pattern, and Impact of Asthma-COPD Overlap Syndrome in Real Life","volume":"149","author":"Palmer","year":"2016","journal-title":"Chest"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Shantakumar, S., Pwu, R.-F., D\u2019Silva, L., Wurst, K., Kuo, Y.-W., Yang, Y.-Y., Juan, Y.-C., and Chan, K.A. (2018). Burden of asthma and COPD overlap (ACO) in Taiwan: A nationwide population-based study. BMC Pulm. Med., 18.","DOI":"10.1186\/s12890-017-0571-7"}],"container-title":["Advances in Respiratory Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2543-6031\/94\/5\/62\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T09:56:33Z","timestamp":1788170193000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2543-6031\/94\/5\/62"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":40,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["arm94050062"],"URL":"https:\/\/doi.org\/10.3390\/arm94050062","relation":{},"ISSN":["2543-6031"],"issn-type":[{"value":"2543-6031","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]}}}