Asthma vs. COPD: Key differences you should know

Asthma and COPD (Chronic Obstructive Pulmonary Disease) are chronic lung conditions that make it harder to breathe. Their overlapping symptoms may create confusion when differentiating the two; however, there are key differences between asthma and COPD. Understanding how they are diagnosed and treated differently for proper disease management is important. Here we will explore asthma and COPD differences and similarities: their causes and risk factors, symptoms, diagnosis, and treatment and prognosis.

What are asthma and COPD? #

Asthma affects over 25 million people living in the United States alone¹. If we could peek inside the airways of someone living with asthma, we would see the muscles around the airways tightening, the airways becoming inflamed, or in some cases both¹. When either event occurs, the airways narrow, and breathing becomes more difficult¹.

COPD is a global threat as the third leading cause of death². According to the World Health Organization (WHO), “COPD is a common lung disease causing limited airflow and breathing problems. It is sometimes called emphysema or chronic bronchitis³.” Phlegm also plays a role and can clog or harm the lungs.

Causes and risk factors: COPD vs. Asthma #

Asthma is generally caused by genetics and the immune system’s overreaction to allergens¹. It often emerges during childhood, although it is seen among all age groups. Risk factors include family history, tobacco exposure in utero, environmental exposures, workplace irritants, fumes, dust, and air pollution¹.

COPD “results from gene(G)-environment(E) interactions occurring over the lifetime(T) of the individual (GETomics) that can damage the lungs/and or alter their normal development/aging processes,” says the Global Initiative for Chronic Obstructive Lung Disease (GOLD)². COPD causes and risk factors include tobacco smoking, air pollution, abnormal lung development, accelerated lung aging, and rare genetic factors such as a-1 antitrypsin deficiency².

COPD vs. asthma symptoms: Similarities and Differences #

Asthma and COPD have overlapping symptoms, such as coughing, wheezing, and difficulty breathing³⁴. However, their differences include other symptoms, the age at which symptoms appear, and the length of time they occur.

Additional asthma symptoms are chest tightness and shortness of breath⁴. Triggers such as dust, smoke, pollen, or animal fur create an environment where symptoms can appear and worsen leading to an asthma attack⁴. Asthma attacks often occur during exercise or at night and are common among children, but the good news is that symptoms do not stay⁴.

Additional symptoms of COPD include tiredness and a chronic cough sometimes accompanied by phlegm³. Unlike asthma, COPD symptoms begin to appear mid-life, and worsening symptoms, known as flare-ups, may span as long as a few days³. Over time, life with COPD becomes more challenging³. Risk of brittle bones, depression, anxiety, heart issues, lung infections, and more are also present with COPD³.

How to diagnose asthma vs. COPD #

A spirometry test diagnoses asthma, and the sooner the diagnosis the better. A UK-wide cohort study finds frequent asthma exacerbations are linked to faster lung function decline, especially in younger patients⁵. Early intervention paired with proper management could help younger patients; however, evidence is still limited and results are mixed⁵.

For COPD diagnosis, spirometry is also used. GOLD states, “…the presence of non-fully reversible airflow obstruction (i.e., FEV1/FVC < 0.7 post-bronchodilation) measured by spirometry confirms the diagnosis of COPD².”

Early diagnosis of COPD is critical to decreasing hospitalization, rates of readmission, and mortality and to treating comorbidities that are common among COPD patients⁶.

Since patients can have both asthma and COPD in what is known as ACO (asthma-COPD overlap) and face greater challenges with more exacerbations and a lower quality of life, appropriate diagnostic tests are critical⁷. A bronchodilator test, in which a bronchodilator medication is given between two spirometry tests, can diagnose COPD accurately and differentiate it from ACO⁷. A study that examined five years’ worth of data from The National Health and Nutrition Examination Survey, found that bronchodilation is an essential element and that spirometry performed without it could cause misclassification and COPD overdiagnosis⁷.

Treatment and prognosis of asthma and COPD #

Neither asthma nor COPD boasts a cure, but treatments are available.

Asthma treatment includes avoiding triggers when possible and using an inhaler⁴. Inhaler medication options are bronchodilators or steroids⁴. While the former provides symptom relief and opens air passages, the latter reduces air passage inflammation⁴. Spirometry tests are administered annually or biannually to track disease progression and manage effective treatment over time¹.

As for COPD, long-acting bronchodilators for daily use and short-acting bronchodilators for flare-ups open the airways⁸. Antibiotics and steroid pills are also used for flare-ups, and oxygen and surgery are options for severe or long cases⁸. Additionally, patients who attend pulmonary rehabilitation learn ways to breathe more easily⁸. Changes in lifestyle such as quitting smoking, getting vaccines and boosters, staying clear of air pollution, and keeping physically active are also recommended⁸.

Comorbidities, such as bronchial asthma, heart disease, osteoporosis, or anxiety and depression to name a few are very common and impact COPD prognosis with lower quality of life and greater risk of hospitalization and mortality, so following clinical treatment guidelines for each condition is vital⁸.

Conclusion #

Proper lung function testing is needed to determine if someone has asthma, COPD, or ACO. If you are experiencing any of the symptoms mentioned above or are exposed to risk factors, contact a medical professional. Early diagnosis leads to better quality of life and disease management.

Written by

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  Kelly Sicard

  MA

  Kelly M. Sicard is a freelance writer with an M.A. in English & Creative Writing who spent over a decade working for a non-profit lung health organization. She lives in New Hampshire with her husband, daughter, and black labrador and enjoys reading, writing, listening to stories, appreciating nature, and spending time with family.