Background <p>Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity disorder caused by <i>Aspergillus</i> sensitization, mostly associated with asthma, but occasionally seen in patients with chronic obstructive pulmonary disease (COPD). This study aimed to analyze the clinical features, treatment responses, and long-term follow-up of patients with ABPA-COPD overlap syndrome.</p> Methods <p>we identified 6 cases of ABPA with underlying COPD from a cohort of ABPA in our hospital. We described symptoms, imaging findings, serology tests, pulmonary functions and treatment outcomes of these cases.</p> Results <p>From January 1st, 2013 to December 31th, 2024, 63 cases of ABPA were diagnosed in our hospital, of them 6 (9.52%) were found to have underlying COPD. The 6 patients were all male, aging from 63 to 89 years, with 5 having a smoking history. The presenting symptoms included persistent cough, sputum and exertional dyspnea. The blood total IgE was markedly elevated (1230–2951 KU/L), and all tested positive for <i>A. fumigatus</i>-specific IgE. Blood eosinophil count was 90-1610 cells/µl. CT revealed bronchiectasis (predominantly lower lobes) and emphysema in all cases. Four patients responded well to oral corticosteroids, while 2 required omalizumab for disease control. After follow-up for 1–4 years, 4 patients remained stable, 1 had recurrent exacerbations, and 1 died due to multi-organ failure.</p> Conclusions <p>ABPA should be considered in COPD patients with persistent or recurrent respiratory symptoms, higher blood eosinophils, particularly those with bronchiectasis on chest CT. ABPA represents a treatable trait in COPD patients. While corticosteroids remain the first-line therapy, treatment-resistant cases may benefit from biologic agents.</p>