The Differences Between COPD and Asthma

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Asthma and chronic obstructive pulmonary disease (COPD) are both respiratory diseases involving chronic inflammation that leads to airflow obstruction. While they share similar symptoms, what triggers symptoms in each is the main difference between the two. In some cases, asthma and COPD may overlap in what is termed asthma-COPD overlap syndrome, or ACOS.

Symptoms

Both asthma and COPD may present with these symptoms:

However, the frequency and predominating symptoms in asthma and COPD are different. With COPD, you are more likely to experience a morning cough, increased amounts of sputum, and persistent symptoms. If you have asthma, you are more likely to experience symptoms in episodes and/or at night.

Another difference between asthma and COPD is the intermittent symptoms seen with asthma versus the chronic, progressive symptoms seen in COPD. Asthma symptoms are likely to occur after exposure to specific triggers, whereas COPD symptoms occur more regularly.

There are a number of other differences between COPD and asthma as well.

Asthma Characteristics
  • Often diagnosed in childhood or adolescence

  • Symptoms more likely to occur in episodes and/or at night

  • Commonly triggered by allergens, cold air, exercise

  • Asthma patients are more commonly nonsmokers

  • Comorbid conditions include eczema and allergic rhinitis

  • Treatment usually involves inhaled steroids

  • Airflow restriction mostly reversible

COPD Characteristics
  • Often diagnosed in adulthood

  • Likely to cause morning cough, increased sputum, and persistent symptoms

  • Exacerbations commonly triggered by pneumonia and flu or pollutants

  • Most patients with COPD have smoked or had significant secondhand smoke exposure

  • Comorbid conditions include coronary heart disease or osteoporosis

  • Treatment usually involves surgery and pulmonary rehabilitation

  • Airflow restriction is permanent or only partially reversible

Once a COPD patient develops symptoms, they are generally chronic. Over time, COPD patients tend to experience symptoms that are not typical for asthma—losing weight, decreasing strength, endurance, functional capacity and quality of life.

Causes

Both asthma and COPD may be considered inflammatory diseases, but the inflammation comes from different types of white blood cells.

In the pathophysiology of asthma, inflammation results acutely from the production of eosinophils, a type of white blood cell that increases in the presence of an allergen. This response causes airways to become inflamed and irritable when triggered by an allergen. When this happens it becomes more difficult to move air in and out of your airways, which leads to asthma symptoms.

In COPD, your lungs become damaged following exposure to certain irritants, most commonly due to chronic cigarette smoking. This chronic exposure and damage lead to airway obstruction and hyperinflation. The pathophysiology of COPD primarily involves the production of neutrophils and macrophages over many years.

Diagnosis

Both conditions are diagnosed via a combination of your history, a physical exam, and testing.

Your physician will likely start by taking a detailed medical and family history and consider those in combination with your reported symptoms and current lifestyle habits (e.g., smoking).

A physical examination will be performed, during which your doctor will listen for signs of wheezing, shortness of breath, and cough. They may also look for signs of nasal inflammation that can make asthma symptoms more pronounced.

A simple, noninvasive breathing test called spirometry is also useful in diagnosing both COPD and asthma. Spirometry is usually performed in a doctor's office, during which your doctor will measure certain aspects of your lung function such as forced expiratory volume (FEV1), or the amount of air that can be forcefully exerted from the lungs in one second.

If your doctor thinks you might have COPD, they will also measure your blood oxygen level via pulse oximetry and a blood test known as arterial blood gases (ABG).

Your physician may also request that you undergo imaging such as an X-ray or computed tomography (CT) scan to show any abnormalities in the lungs and to potentially rule out any other conditions.

Treatment

Asthma and COPD are treated and respond to treatments differently because the source of inflammation is different. The goals of treatment in asthma and COPD are also different.

Asthma Treatment Goals: In asthma, your doctor will attempt to lower or suppress inflammation through medications as outlined below.

COPD Treatment Goals: The goal of COPD treatment is to reduce symptoms and prevent the progression of damage to the lung while decreasing exacerbations and improving quality of life.

Airflow Restriction: Reversible or Permanent?

In asthma, treatment generally returns your lung function to normal or near-normal and you should not have many asthma symptoms between asthma exacerbations. For this reason, airflow restriction in asthma is considered reversible, though some patients with severe asthma do develop irreversible damage.

However, even with treatment, a COPD patient's airflow restriction and lung function will likely not return to normal and or may only partially improve—even with smoking cessation and bronchodilator usage.

Medications

While your doctor may use some of the same medications for the treatment of asthma and COPD, the "when, why, and how" of these medications may be different. Medications used in both asthma and COPD may include inhaled steroids, anticholinergics, short-acting bronchodilators, and long-acting beta-agonists.

Inhaled Steroids

Inhaled steroids, such as Flovent, are advantageous in both asthma and COPD because the medication acts directly in the lung. However, inhaled steroids are used differently in asthma and COPD.

In asthma, inhaled steroids are typically used first when a daily medication becomes necessary, usually after a patient progresses from intermittent to mild persistent asthma. In COPD, inhaled steroids are added after patients develop severe COPD and multiple exacerbations.

Anticholinergics

Short-acting anticholinergics, such as Atrovent, are used in the treatment of acute asthma exacerbations, while the long-acting anticholinergic Spiriva is prescribed as a controller medication in asthma.

Spiriva is also used relatively early in COPD because it has been associated with improvements in lung function, symptoms, and quality of life while decreasing COPD exacerbations and hospitalizations. 

Short-Acting Bronchodilators (SABAs)

In asthma, SABAs are used for the periodic relief of acute symptoms. But once you use a SABA enough to meet the criteria for mild persistent asthma, additional medication is required.

In contrast, scheduled SABAs are one of the first treatments used for COPD.

Long-Acting Beta-Agonists (LABAs)

While long-acting beta-agonists like Serevent may be used as a convenient method of initial COPD treatment, these drugs are not indicated in asthma until you have moderate persistent asthma.

Bronchial Thermoplasty

In this asthma-only treatment, patients with severe persistent asthma that is not well-controlled with inhaled corticosteroids and long-acting beta-agonists, undergo a bronchoscopy that applies heat to your airways to decrease their ability constrict and narrow following exposure to triggers that can lead to an asthma attack.

Surgery

This is only available for COPD. This treatment is generally reserved for patients who have failed medical therapy. There are now some less invasive treatments, such as lung volume reduction surgery (LVRS), that can remove severely damaged lung tissue (up to 30% of lung volume) so that the remaining lung tissue can function more efficiently. LVRS is performed with video assistance and is considered a minimally invasive procedure.

Overlap Syndrome

While asthma and COPD have long been thought of as two separate conditions, clinicians have begun to come across patients with features of both conditions in what is now termed overlap syndrome, more specifically known as asthma-chronic obstructive pulmonary disease (ACOS).

COPD patients are increasingly noted to have an asthma component in addition to their COPD; studies have shown that anywhere from 10% to 20% of COPD patients also have asthma. Surprisingly, 1 in 4 asthma patients smokes and is at risk for COPD like any other smoker.

The primary complication with ACOS is that if a patient with COPD also has features of asthma, it usually means more frequent exacerbations, worse quality of life, and more comorbidities (other diseases or conditions occurring at the same time). In general, the prognosis is worse, but it is not known if asthma symptoms cause COPD to progress faster.

Treatment for ACOS consists mostly of symptom management and depends on which condition is more predominant. Medications such as low-dose corticosteroids, long-acting bronchodilators, and long-acting muscarinic agonists may be used along with lifestyle changes.

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Article Sources
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