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 Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS): current literature review Antonis Papaiwannou1, Paul Zarogoulidis1, Konstantinos Porpodis1, Dionysios Spyratos1, Ioannis Kioumis1, Georgia Pitsiou1, Athanasia Pataka1, Kosmas Tsakiridis2, Stamatis Arikas2, Andreas Mpakas2, Theodora Tsiouda3, Nikolaos Katsikogiannis4, Ioanna Kougioumtzi4, Nikolaos Machairiotis4, Stavros Siminelakis5, Alexander Kolettas6, George Kessis7, Thomas Beleveslis8, Konstantinos Zarogoulidis1 J Thorac Dis 2014;6(S1):S146-S151. doi: 10.3978/j.issn.2072-1439.2014.03.04  Definitions Asthma is recognised as an allergic disease, usually starting in childhood, characterized by reversible airflow obstruction with episodic course and favourable prognosis in general, due to good response to anti-inflammatory treatment. On the contrary, chronic obstructive pulmonary disease (COPD) is typically caused by tobacco smoking, develops after the fourth decade of life and displays incompletely airflow obstruction, resulting in progressive decline in lung function and premature death. American Thoracic Society (ATS), in their guidelines of 1995 (1) defined asthma, chronic bronchitis, emphysema, COPD, airflow obstruction and identified 11 distinct syndromes. There was an overlap at 6 of these 11 syndromes. Overlap syndrome percentages are increased from mid to later life progressively (2). The Spanish COPD guidelines propose four COPD phenotypes that determine differential treatment: nonexacerbator with emphysema or chronic bronchitis, mixed COPD—asthma, exacerbator with emphysema and exacerbator with chronic bronchitis (3). The mixed COPD—asthma phenotype was defined as an airflow obstruction that is not completely reversible accompanied by symptoms or signs of an increased reversibility of the obstruction (3). In another recent study from Spain, as well, Soler-Catalu?a et al. defined the clinical phenotype known as “overlap phenotype COPD-asthma” (4). For this diagnos