Patient handout

Asthma–COPD Overlap (ACO) — GINA/GOLD 2026 ICS-foundation

PRODUCTION

1. Your condition

This handout is for asthma–copd overlap (aco) — gina/gold 2026 ics-foundation. Your care team identified this based on: persistent airflow limitation with features of both asthma and copd (variable + persistent obstruction, smoking + atopy) — gina 2026 / gold 2026 joint aco description.

Other reasons your team may use this plan: post-bd fev1/fvc <0.70 (fixed, copd-like) and large bronchodilator reversibility (≥12% and ≥200 ml, or fev1 variability ≥400 ml — asthma-like) (cataldo pmid 28243078); established copd with a documented physician diagnosis of asthma before age 40 (caillaud/roche initiatives bpco pmid 27501862); established asthma in a smoker/ex-smoker (≥10 pack-years) who develops incompletely reversible obstruction (smoking-asthmatic aco phenotype — toledo-pons pmid 30677059).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
budesonide-formoterol	160/4.5 µg 2 puffs BID (or per asthma-component severity)	inhaled	BID (MART possible for the asthma component)	ICS-containing foundation per GINA/GOLD 2026 joint ACO description — ICS treats the eosinophilic/asthma component; budesonide-formoterol also supports a MART reliever strategy. RxCUI 19831 = budesonide IN (combination — NEEDS_RXNAV_VALIDATION for SCD/SBD; not hand-authored)
fluticasone furoate-vilanterol	100/25 µg or 200/25 µg Ellipta 1 inhalation daily	inhaled	once daily	Alternative once-daily ICS/LABA foundation (GINA/GOLD 2026). RxCUI 41126 = combination base-ingredient code — NEEDS_RXNAV_VALIDATION for SCD/SBD

Plan: ACO ICS-containing foundation — ICS/LABA → triple ICS/LABA/LAMA (GINA/GOLD 2026 joint)

3. When to call your provider

Contact your care team if any of the following happen:

Acute severe exacerbation with O2 requirement / life-threatening features → ED (treat as worse-of-both physiology)
Persistent uncontrolled on triple with ≥2 exacerbations/yr → severe-asthma/ACO specialty clinic for biologic assessment (ATS/ERS 2024)
Diagnostic uncertainty (is it pure asthma, pure COPD, bronchiectasis, IPF?) → re-route via the discrimination workup

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Acute severe ACO exacerbation — behaves like the WORSE of asthma and COPD (higher exacerbation burden than COPD alone, IRR 1.65, Jo/Rhee PMID 31953230): severe airflow obstruction + hypoxia, OR life-threatening asthma-like features (silent chest, exhaustion), OR type-II respiratory failure (COPD component)

5. Follow-up

Written action plan, vaccinations (influenza, pneumococcal PCV20 or PCV15+PPSV23, RSV, COVID, Tdap), smoking-cessation reinforcement, pulmonary rehab within 3 weeks of any exacerbation, allergen/trigger control, 1-week post-exacerbation follow-up, advance-care planning in advanced disease (GINA/GOLD 2026)

6. Sources

Guideline: GINA 2026 Strategy Report (released May 2026) + GOLD 2026 Report — JOINT asthma–COPD overlap (ACO) description (ACO is a clinical description, not a single disease; ICS-containing therapy foundational)