Differences Between Asthma and COPD

Differentiating between asthma and COPD didn't use to be a problem. COPD was primarily a problem of older men who smoked. As more women and younger people began smoking, however, the face of COPD began to change.

Man performing lung function test
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As a result, asthma and COPD can now sometimes be confused. Asthma and COPD occur in both young and old, men and women. We will consider factors that will help you differentiate between asthma and COPD.

Additionally, COPD has a social stigma that society has placed on it. As a result, I often have patients present to me stating they have asthma when they really have COPD. This creates treatment dilemmas as the treatments for these two conditions are not the same.

Are Asthma and COPD the Same?

The symptoms of asthma and COPD are similar in that they can both lead to:

These symptoms are experienced differently in asthma and COPD. With COPD, you are more likely to experience a daily morning cough productive of phlegm. Changes in the coughing pattern and color of phlegm are often used by your healthcare provider as clues if a COPD exacerbation is present. Daily coughing is characteristic of chronic bronchitis, a type or variant of COPD.

Chest tightness and intermittent cough (especially at night) are more common with asthma. These symptoms will wax and wane with your asthma control. When your asthma is well controlled, you experience periods of time when you are symptom-free.

However, the pathophysiology of asthma and COPD are very different. While the symptoms may be similar, the process leading up to the symptoms is different.

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

In the pathophysiology of asthma, inflammation results acutely from the production of eosinophils, while inflammation in COPD primarily involves the production of neutrophils and macrophages over many years.

Several questions may help you know which condition you might have:

  • How old was I when I was diagnosed? COPD is generally a disease of older people, while most, but not all, asthma is diagnosed during childhood or adolescence. COPD is not commonly diagnosed before the age of 40.
  • Have I ever smoked? While many asthma patients smoke, most asthma patients have never smoked. While some patients with COPD have never smoked, more than 80% of patients diagnosed with COPD have either smoked in the past or are current smokers.
  • What leads to symptoms? Most COPD patients experience daily symptoms while asthma patients have significant intervals without symptoms. Further, asthma patients typically have triggers such as pollen or other exposures that, if avoided, result in an absence of symptoms. Asthma patients lung function also returns to normal or near normal after an exacerbation with the treatment of bronchoconstriction, airway hyperresponsiveness, and airway inflammation. COPD patients may experience a slow decline in lung function by quitting smoking, but their lung function never returns to normal. COPD patients usually seek care because of shortness of breath and eventually, COPD patients have a decreased exercise capacity. Over time COPD patients tend to lose weight, have decreased strength, and quality of life in addition to their decreased functional capacity.

To make this issue a little more confusing, some COPD patients can have an asthma component. Additionally, some asthma patients smoke and are at risk for developing COPD-like any other smoker.

Some COPD patients demonstrate reversibility on pulmonary lung function testing. When there is a reversible component to your COPD, you may be said to have an asthma component. When there is very little to no reversibility, no asthma component is present. The American Thoracic Society defines reversibility as a post-bronchodilator increase in FEV1 of at least 12% for both COPD and asthma.

In this case, the diseases are not the same. The amount of reversibility is generally significantly less in a COPD patient compared to an asthmatic.

Are the Symptoms of Asthma and COPD The Same?

Asthma and COPD can both cause wheezing, chest tightness, shortness of breath, and chronic cough. 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. Additionally, asthma symptoms are likely to occur after exposure to specific triggers.

Are Asthma and COPD Treatments the Same?

While your healthcare provider may use some of the same medications for the treatment of asthma and COPD, the "when, why, and how" of these medications may actually be different.

The goal of treatment in asthma is to be symptom-free with near-normal lung function while the goal of COPD treatment is to prevent the progression of damage to the lung, decrease exacerbations, and improve the quality of life. Medications used in both asthma and COPD may include:

  • Inhaled steroids: Inhaled steroids, such as Flovent, are advantageous in both asthma and COPD because the medication acts directly in the lung -- but 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 you progress from intermittent to mild persistent asthma. In COPD, inhaled steroids are added after patients develop severe COPD and multiple exacerbations.
  • Anticholinergics: While short-acting anticholinergics, such as Atrovent, are used in the treatment of acute asthma exacerbations, long-acting anticholinergics like Spiriva are generally not used as a controller medication in asthma. Spiriva, however, is 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. On the other hand, scheduled SABAs are one of the first treatments 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, LABAs are not indicated in asthma until you have moderate persistent asthma.
  • Surgery: This is only available for COPD. This treatment is generally reserved for patients that have failed medical therapy. There are now some less invasive treatments where patients can gain the benefits of lung reduction surgery through a much less invasive procedure.
  • 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.

If you are not sure if you have COPD or asthma, make sure you see a healthcare provider before attempting any kind of treatment plan.

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