How Do You Know If It Is Asthma or COPD?

It's Not Always Easy To Tell

Is it asthma or COPD? It’s not always easy for you or your doctor to tell. While these conditions can sometimes overlap, it is often possible to tell which is more likely.

A reader recently wrote to me confused by something her doctor told her. She writes:

“My pulmonologist diagnosed me with chronic obstructive asthma. When I Google that term, COPD comes up. Does that mean I have COPD as well as asthma?  I am a 54 y.o woman who never had asthma as a child. I developed problems with my lungs following a bad cold this past winter.  I’ve never smoked cigarettes. I have asthma symptoms almost every day.

My medications are ProAir for a rescue inhaler, Symbicort BID, Singulair HS and I am using my home nebulizer BID also.  

I was hospitalized two weeks ago for an asthma attack for three days and received IV steroids and nebulizer treatments every 8 hours and was discharged on a prednisone taper starting at 40 mg for 3 days.  When I had the severe asthma attack that sent me to the ER, I was already tapering off prednisone.”

So does she have asthma, COPD, or both? Answering a number of questions may help determine if it is asthma or COPD. A small number of patients may also have a mixed picture. While many of the treatments are the same, how you take treatments, your prognosis, and a number of other factors are different.

Did I Have Symptoms As a Child?

Some people develop symptoms and are diagnosed with asthma in adulthood. However, asthma most occurs in children and adolescents. In fact, many older patients diagnosed with asthma really have COPD. Asthma is termed bimodal or U-shaped disease because we normally see most patients diagnosed in the early years, but there is this significant spike among patients between ages 35 to 40. Environmental tobacco smoke, pet avoidance and visible mold problems in the home have have all been explored as possible reasons for this second peak. Late onset asthma makes up most of the asthma cases in adulthood ad may represent a more severe type that is associated with higher economic costs and is more difficult to control clinically.

What Makes My Asthma Symptoms Worse?

While asthma and COPD both have obstruction, inflammation, and airway hyperresponsiveness as part of the disease process, asthma is primarily an allergic disease and patients often know what makes their symptoms worse such as:

COPD is not usually triggered, but is often made worse by respiratory tract infections.

Do I Smoke?

While smoke may trigger asthma symptoms, COPD is more common in smokers, former smokers, or patients exposed to passive smoke.

Do I Have Any Symptom Free Periods?

Asthma symptoms are intermittent, reversible, and lung function tests (e.g. FEV1 and spirometry) either return to normal or significantly improve between asthma exacerbations. Symptoms with COPD, on the other hand, are irreversible and often progressive. Most COPD patients experience regular if not daily symptoms. These symptoms do not seem to fluctuate over time as COPD symptoms due. Similarly, COPD patients need to take medications daily and do not seem to benefit from an action plan as asthma patients do. Similarly, COPD patients are not able to monitor symptoms and adjust medication as asthma patients can successfully do. Finally, COPD is often progressive where as asthma is not.

Could You Have Mixed Disease?

Although not well studied, doctors are increasingly acknowledging a mixed disease process. These physicians believe in what is called the “Dutch hypothesis” where asthma and COPD are on the same disease continue rather than being separate, distinct diseases. The hypothesis promotes the idea that disease in the adult lung is the product processes developing and progressing throughout childhood. The symptoms in the adult are a final by product of one disease process.

Patients with overlap are generally older. Most commonly these patients are either:
1. smokers with asthma
2. nonsmokers with long-standing asthma that progresses to COPD

On functional testing overlap patients have disease that partially behaves like asthma and partially like COPD. There is some debate in the medical literature as to whether this actually represent 2 diseases. Treatment, however, is not all that different, but there are no randomized clinical trials to help guide your doctor's treatment. As this population is typically older there is increased risk of not tolerating inhalers or experiencing side effects or comorbidities from inhalers. Your doctor will discuss smoking cessation,  and vaccines as appropriate. If you need oxygen supplementation or pulmonary rehabilitation these are both reasonable. If your symptoms and testing reveal that your disease is more like COPD, your doctor will likely go down that route and vice versa for asthma.

What Is Your Biggest Asthma Problem?

We want to help you get control of your asthma. I want to hear about your biggest asthma problem so that we can try to help you develop a solution or better understand how to help.? You are probably not the only one with the problem. Take a few minutes describing your problem so we can develop a solution together.

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