Asthma and COPD: How to Tell the Difference

Medically reviewed by Elaine K. Luo, MD on March 27, 2017Written by Erica Cirino, Joann Jovinelly, and Rena Goldman

Why asthma and COPD are often confused

Chronic obstructive pulmonary disease (COPD) is a general term that describes progressive respiratory diseases like emphysema and chronic bronchitis. COPD is characterized by decreased airflow over time, as well as inflammation of the tissues that line the airway.

Asthma is usually considered a separate respiratory disease, but sometimes it’s mistaken for COPD. The two have similar symptoms. These symptoms include chronic coughing, wheezing, and shortness of breath.

According to the National Institutes of Health (NIH), around 24 million Americans have COPD. About half of them don’t know that they have it. Paying attention to symptoms — especially in people who smoke, or even used to smoke — can help those with COPD get an earlier diagnosis. Early diagnosis can be crucial to preserving lung function in people with COPD.

About 40 percent of people who have COPD also have asthma. Asthma is considered a risk factor for developing COPD. Your chance of getting this dual diagnosis increases as you age.

Asthma and COPD may seem similar, but taking a closer look at the following factors can help you tell to the difference between the two conditions.

Age

Airway obstruction occurs with both diseases. The age of initial presentation is often the distinguishing feature between COPD and asthma.

People who have asthma are typically diagnosed as children, as noted by Dr. Neil Schachter, medical director of the respiratory care department of Mount Sinai Hospital in New York. On the other hand, COPD symptoms usually show up only in adults over the age of 40 who are current or former smokers, according to the NIH.

Causes

The causes of asthma and COPD are different.

Asthma

Experts aren’t sure why some people get asthma, while others do not. It’s possibly caused by a combination of environmental and inherited (genetic) factors. It is known that exposure to certain kinds of substances (allergens) can trigger allergies. These differ from person to person. Some common asthma triggers include: pollen, dust mites, mold, pet hair, respiratory infections, physical activity, cold air, smoke, some medications such as beta blockers and aspirin, stress, sulfites and preservatives added to some foods and beverages, and gastroesophageal reflux disease (GERD).

COPD

The known cause of COPD in the developed world is smoking. In developing countries, it’s caused by exposure to fumes from burning fuel for cooking and heating. According to the Mayo Clinic, 20 to 30 percent of people who smoke on a regular basis develop COPD. Smoking and smoke irritate the lungs, causing the bronchial tubes and air sacs to lose their natural elasticity and over-expand, which leaves air trapped in the lungs when you exhale.

About 1 percent of people with COPD develop the disease as a result of a genetic disorder that causes low levels of a protein called alpha-1-antitrypsin (AAt). This protein helps protect the lungs. Without enough of it, lung damage occurs easily, not just in long-term smokers but also in infants and children who have never smoked.

Different triggers

The spectrum of triggers that cause COPD versus asthma reactions are also different.

Asthma

Asthma is usually made worse by exposure to the following:

  • allergens
  • cold air
  • exercise

COPD

COPD aggravations are largely caused by respiratory tract infections such as pneumonia and the flu. COPD can also be made worse by exposure to environmental pollutants.

Symptoms

COPD and asthma symptoms seem outwardly similar, especially the shortness of breath that happens in both diseases. Airway hyper-responsiveness (when your airways are very sensitive to things you inhale) is a common feature of both asthma and COPD.

Comorbidities

Comorbidities are diseases and conditions that you have in addition to the main disease. Comorbidities for asthma and COPD are also often similar. They include:

One study found that more than 20 percent of people with COPD have three or more comorbid conditions.

Treatments

Asthma

Asthma is a long-term medical condition but is one that can be managed with proper treatment. One major part of treatment includes recognizing your asthma triggers and taking precautions to avoid them. It’s also important to pay attention to your breathing to make sure your daily asthma medications are working effectively. Common treatments for asthma include:

  • quick-relief medications (bronchodilators) such as short-acting beta agonists, ipratropium (Atrovent), and oral and intravenous corticosteroids
  • allergy medications such as allergy shots (immunotherapy) and omalizumab (Xolair)
  • long-term asthma control medications such as inhaled corticosteroids, leukotriene modifiers, long-acting beta agonists, combination inhalers and theophylline
  • bronchial thermoplasty

Bronchial thermoplasty involves heating the inside of the lungs and airways with an electrode. It shrinks the smooth muscle inside the airways. This reduces the airway’s ability to tighten, making it easier to breath and possibly reducing asthma attacks.

Asthma medications »

COPD

Like asthma, COPD is a long-term health condition, and the goal of treatment is to control symptoms so you can lead an active and healthy life. Because it is a progressive condition, another main objective of treatment is to prevent the condition from worsening. You should quit smoking and avoid exposure to secondhand smoke. This is the only way to prevent COPD from getting worse. Some quitting methods include nicotine replacement products and medications, as well as therapy, hypnosis, and support groups.

Other common treatments for COPD include:

  • medications such as bronchodilators, inhaled steroids, combination inhalers, oral steroids, phosphodiesterase-4 inhibitors, theophylline, and antibiotics
  • lung therapies, including oxygen therapy and pulmonary rehabilitation programs involving education, exercise training, nutritional advice, and counseling to increase your quality of life
  • surgeries such as lung volume reduction surgery (removing areas of damaged lung tissue to increase space in the chest cavity for the remaining healthy lung tissue), lung transplant (replacing diseased and damaged lungs with healthy, donated lungs), or bullectomy (removal of abnormally large air spaces from the lungs to help improve breathing)

COPD: Treatment options »

Response to treatment

Both COPD and asthma respond well to treatments like quitting smoking and airway-opening medications like bronchodilators. However, lung function is only fully reversible in people with asthma. A diagnosis of asthma along with COPD often means a faster decline in lung function as COPD progresses. This is still the case even in people with mild forms of the disease.

Outlook

Both asthma and COPD are long-term conditions that can’t be cured, but the outlooks for each differ. Asthma tends to be more easily controlled on a daily basis. Whereas COPD worsens over time. While people with asthma and COPD tend to have the diseases for life, in some cases of childhood asthma, the disease goes away completely after childhood. Both asthma and COPD patients can reduce their symptoms and prevent complications by sticking to their prescribed treatment plans.

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