Asthma Vs. COPD: Seeing The Difference

There are many similarities between chronic obstructive pulmonary disease (COPD) and asthma, especially in the early stages of each condition. Both may cause breathing difficulties along with wheezing and coughing. However, it's essential to diagnose the conditions correctly, as the treatment and prognosis for the two are very different. 

Learn more about the difference between asthma and COPD, their symptoms, treatments, causes, and when you should see a doctor about your symptoms. 

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What are COPD and asthma?

COPD and asthma are both medical conditions that affect the lungs. While the two conditions share many similarities, especially when it comes to the initial symptoms, there are very important differences between them. 

COPD

Around 16 million Americans¹ have COPD. COPD is an umbrella term for several lung conditions, including emphysema and chronic bronchitis. The primary cause of COPD is smoking. However, you may develop the disease through exposure to air pollution, as a result of respiratory infections, or due to your genetic makeup.

COPD is a chronic disease, meaning once you have it, you'll need to manage the symptoms of it for the rest of your life. COPD is typically diagnosed in people over the age of 40 and may initially present with symptoms that look a lot like asthma. 

However, the symptoms of COPD will get worse over time. The airways will become more restricted, which can make it increasingly difficult to move air in and out of the lungs. It's currently the fourth leading cause of death² globally. While there is no cure, it's possible to slow the disease's progress with early diagnosis and a good treatment plan.

Asthma

Around 1 in 13 people in the United States³ have asthma. That's about 25 million people. This chronic condition of the lungs may be diagnosed at any age. The condition results in asthma attacks, where periodic inflammation in the airways causes them to swell and narrow. This makes it difficult to move air in and out of the lungs. The symptoms of an asthma attack may include wheezing, coughing, shortness of breath, and tightness in the chest.

There is no cure for asthma, but it's usually a treatable condition. A doctor can help you identify your asthma triggers and develop a treatment plan that may include both preventative medications as well as rescue inhalers to stop symptoms during an asthma attack. 

Is there a link?

While they are two distinct conditions, COPD and asthma share many similarities, especially regarding their symptoms. Both COPD and asthma are chronic inflammatory diseases, which means they are caused by inflammation in the lungs.

It's possible for asthma to develop into COPD. This happens if asthma goes untreated or gets worse over time. Refractory asthma is a severe form of asthma in which patients don't respond well to medication. They may have frequent asthma attacks and decreased lung function. This is classified as a COPD disease.

Nearly half of people with COPD also have asthma,⁴ with co-morbidity becoming more common as patients get older and their lung function decreases. When you do have both conditions at the same time, this is called Asthma-COPD overlap syndrome.

Symptoms

COPD and asthma share many of the same symptoms, especially in the beginning stages of COPD. Some of the symptoms they have in common include: 

  • Coughing 

  • Wheezing

  • Feeling short of breath after mild physical activity

  • Having trouble taking a deep breath

  • Feeling more tired than usual

The symptoms of COPD and asthma will differentiate over time, especially as COPD progresses. Your doctor will take a thorough medical history and may track your symptoms over time to determine if you have asthma, COPD, or both. 

COPD symptoms

There are certain symptoms that are  more common in COPD, such as coughing up a lot of phlegm or mucus. COPD symptoms are also more consistent than asthma, meaning they don't necessarily go away with the help of a nebulizer or rescue inhaler. 

The symptoms of COPD will also get worse over time, progressing from stage I to stage IV. Someone with COPD might experience symptoms such as fast, shallow breathing or developing a blue tint to their skin due to lack of oxygen.

Asthma symptoms

Asthma is more likely to create a feeling of tightness in the chest. Asthma symptoms are also more periodic and often ease or go away with medication or a device like a rescue inhaler. As long as you are able to avoid triggers, it's possible to avoid feeling any asthma symptoms for long periods of time. 

Causes

The causes of COPD and asthma are very different. Understanding the causes can help patients and doctors prevent these conditions and, in the case of COPD, slow its progression. 

Causes of COPD

COPD is primarily caused by cigarette smoke. This accounts for up to 90%⁵ of COPD cases. Chemicals inhaled through smoking can make your lungs prone to infection and cause the airways to inflame and narrow. This can lead to the development of COPD.

Smoking is the number one risk factor in the development of COPD, and stopping smoking can reduce your risk and slow the progression of the disease.

The remaining cases of COPD are due to factors such as: 

  • Environmental toxins: inhaling air pollution, industrial chemicals, or chemical fumes 

  • Alpha-1 antitrypsin deficiency: Alpha-1 antitrypsin is a protein that protects the lungs from inflammation; a small number of people have a genetic condition that prevents their bodies from producing enough Alpha-1 protein 

Causes of asthma

It's unclear why some people develop asthma, and others do not. It's probably a mix of factors, such as: 

  • Genetics: If you have one parent with asthma, you have a 25%⁶ risk developing it yourself. If both of your parents have the condition, your risk goes up to 50%. 

  • Environment: You may be more at risk if you had certain types of respiratory infections or viruses as a child. Exposure to certain chemicals may also contribute to the development of asthma. 

There is a difference between what causes asthma and what triggers asthma attacks. Triggers are factors known to start an asthmatic episode, which are different for everyone. Pet dander may trigger one person's asthma while another may react to strong emotions or air pollution. Knowing and understanding your asthmatic triggers is important in managing the condition.

Treatment

Both COPD and asthma have many treatment options available. Your doctor will work with you to tailor a treatment plan to address and ease your specific symptoms. 

COPD treatments

  • Lifestyle changes: If you are a smoker, work with your doctor to create a plan to help you quit. Smoking is the primary cause of COPD, and continuing to smoke may worsen the outcomes of the condition. 

  • Medications: COPD medications may either provide long-term preventative treatments or short-term rescue medications. Your doctor may recommend antibiotics, corticosteroids, or a combination to address your specific symptoms and health concerns. Medications will work to prevent respiratory infections while reducing any swelling in the airways and making it easier for you to breathe. 

  • Pulmonary rehabilitation:  This can teach you how to exercise without losing your breath or modify your behavior, so you can perform daily tasks with decreased lung function. This can decrease the frequency and severity of symptoms while increasing physical activity and improving your quality of life. 

  • Supplemental oxygen: As the symptoms of COPD progress, some people may find it necessary to use supplemental oxygen. This will help your body get the oxygen it needs even as lung function decreases. 

Asthma treatments 

  • Lifestyle change: If you are a smoker, you should try to quit smoking as soon as possible. Cigarette smoke is a common trigger for asthma attacks. You may need to make other lifestyle changes to avoid your particular asthma triggers, such as changing your diet or avoiding high-stress situations. 

  • Medications: Your doctor may recommend a combination of medications to prevent the onset of your symptoms and provide rescue relief during an asthma attack. These medications might include bronchodilators, steroids, anti-inflammatories, or a combination. Many people take these medications through an inhaler, which delivers the medications directly to the lungs. 

  • Biologics: This injectable treatment is given by your doctor or taken home every few weeks. Biologics target the production of certain proteins in the body that cause inflammation and swelling in the lungs. Your doctor may recommend them if you aren't responding well to other treatment options.

Prevention

COPD is the more preventable of the two conditions. The easiest way to prevent COPD is to avoid smoking. Smoking accounts for the vast majority of COPD cases, so if you stop smoking or never start, your risk of developing the disease decreases dramatically. 

You can also prevent COPD by reducing your exposure to toxic chemicals and air pollution. If you have a family history of COPD, though, it may be more difficult to prevent.

Unfortunately, there is no way to effectively prevent asthma. That's due in large part to the fact that it's unclear why asthma develops in the first place. There is a strong genetic link, though, which makes it harder to avoid. 

While you can't prevent the development of the condition, you can help reduce the frequency and severity of its symptoms by avoiding your asthmatic triggers. You should also stick to the treatment plan set up by your doctor to help prevent asthma attacks.

Which is more serious, asthma or COPD?

Both COPD and asthma are serious health conditions. They can both cause difficulties breathing and may get worse rapidly without effective treatment. Both can result in hospitalization and, in the most severe cases, death.

COPD is a deadlier disease. In 2020, more than 4,000 people died from asthma³ while more than 150,000 people die from COPD⁷ every year in the United States. This is due to the fact that COPD symptoms will continue to worsen over time. This makes it more difficult to manage the symptoms and results in reduced lung function.

Some asthma sufferers can avoid their triggers almost entirely, thus reducing the severity of their condition. Around 50% of children⁸ with asthma will stop having symptoms by the time they become adults. 

With a COPD diagnosis, however, it's unlikely that patients will regain function in their lungs. They can slow the progress of the disease with an effective treatment plan.

Any interruption to your oxygen supply, whether from COPD, asthma, or another condition, is cause for serious concern. 

When to visit your doctor

If you are experiencing symptoms such as tightness in the chest, shortness of breath, persistent coughing, or wheezing, make an appointment with your doctor. These may be indications that you are suffering from asthma, COPD, or another underlying health condition. Your doctor can help you determine the cause of your symptoms and create a treatment plan to manage them. 

The lowdown

COPD and asthma are both common chronic inflammatory diseases affecting the lungs. They share many of the same symptoms, including coughing, wheezing, and shortness of breath, which may initially make them difficult to diagnose.

However, asthma symptoms usually happen periodically when you come into contact with a trigger such as pet dander, air pollution, or an emotionally-charged situation. COPD symptoms are more consistent and will get worse over time. 

While it's unclear what causes asthma, researchers believe it's a combination of genetic and environmental factors. Smoking is the cause of up to 90% of cases of COPD, while the remaining cases may be due to exposure to toxic chemicals or rare genetic markers. 

Treatments for both conditions may involve long-term management of the symptoms and rescue relief for temporary symptoms. Those with COPD may also benefit from pulmonary rehabilitation and supplemental oxygen. Both conditions can be serious and even deadly, but COPD claims more lives every year in the U.S. and is the fourth leading cause of death globally. 

If you are experiencing any of the symptoms of COPD or asthma, make an appointment with your doctor. Early diagnosis and treatment may help improve your outcome.

  1. What is COPD? | Centers for Disease Control and Prevention

  2. Asthma and chronic obstructive pulmonary disease (COPD) – Differences and similarities (2012)

  3. Asthma facts and figures | Asthma and Allergy Foundation of America

  4. The clinical features of the overlap between COPD and asthma (2011)

  5. COPD causes and risk factors | American Lung Association

  6. Does asthma run in the family? | Global Allergy and Airways Patient Platform

  7. COPD | Centers for Disease Control and Prevention

  8. Asthma in infants and young children | Asthma and Allergy Foundation of America

Other sources:

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