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In the 1960s, experts proposed the Dutch Hypothesis, which stated that (1) asthma and chronic obstructive pulmonary disease (COPD) are different expressions of the same disease that has been shaped by environmental influences and (2) that asthma predisposes patients to COPD later in life. This theory was countered by the British Hypothesis, which claimed that asthma and COPD are separate disease processes. In 2015, an international panel defined asthma–COPD overlap syndrome (ACOS) as “persistent airflow limitation with several features usually associated with asthma and several usually associated with COPD.” Our knowledge about ACOS is limited, because clinical trials typically exclude patients with features of both diseases.
Asthma is chara…