Is It Asthma or COPD... or Both?

Asthma and chronic obstructive pulmonary disease (COPD for short) are similar conditions that can be confusing to distinguish from one another. This article looks at the similarities and differences and how to tell the difference. We also answer the question of whether you can have both conditions.

How asthma and COPD are similar?

There are a number of ways that asthma and COPD are similar. This is what results in most of the confusion between the two different conditions. For example:¹

• Both are chronic respiratory conditions with no known cure.
• Both have airways that are inflamed. leading to swelling, narrowing, and blockage of the air passages.
• In both, the airways can overreact to certain allergens or other environmental conditions/substances.
• Both diseases can have the symptoms of: cough, shortness of breath, wheezing and chest tightness.
• Both asthma and COPD are often treated with the same medications.

How they are different?

Although there are many things alike about asthma and COPD, there are also some clear differences.

Underlying causes

The underlying cause of airway inflammation is different. Asthma inflammation stems from sensitivity to substances called allergens that stimulate the production of a type of white blood cell called eosinophils. This inflammation is relatively short-term. (Allergens include things such as pollen, pet dander, dust mites, and molds.)¹

On the other hand, the inflammation with COPD stems from the production of white blood cell types called macrophages and neutrophils. It results over a longer period of exposure to environmental irritants such as tobacco smoke, typically over many years.¹

The start of symptoms

They typically strike at different times during life. Asthma is commonly diagnosed during childhood, although it can arise during adulthood as well. COPD typically begins after the fourth decade of life.¹

Reversibility

Asthma is partly reversible, while COPD is not. In asthma, the airway symptoms are often reversible with the right approach to treatment. They may even lessen or disappear after childhood. With COPD, the airways tend to be permanently damaged and not reversible. With quitting smoking and the right treatment, airway damage can be stopped or at least slowed, but not repaired. COPD will eventually progress and get worse over time. How soon that happens varies greatly and can take many years.¹

Symptoms overtime

With asthma, symptoms are intermittent, while in COPD, symptoms are ever-present and worsen over time. Because asthma is a reaction to changing environmental conditions, i.e., allergen exposure, symptoms come and go. With COPD, the inflammation in the airways tends to be constant, though it can worsen in the presence of irritants in the air. But symptoms, although they can fluctuate in intensity, are fairly constant and will get worse as time goes on.¹

Comorbidities

Co-existing conditions tend to be different. Because asthma is an allergic disease most often, co-existing conditions tend to be allergic in nature. Things like nasal allergies and eczema are common. In adults with asthma, gastroesophageal reflux disease (GERD for short) is also common. On the other hand, people who have COPD are more likely to have co-existing conditions more associated with age, such as heart disease or osteoporosis.¹

Treatment

Treatment is not the same. In people with asthma, inhaled steroids are the treatment of choice to control airway inflammation. However, people with COPD may be treated with inhaled steroids sometimes, but generally do not respond as well to this type of medicine. They are more likely to benefit from a bronchodilator medication.¹

Can you have both?

The answer to this question is yes. Some people have asthma prior to developing COPD, while others who have COPD may be at risk for developing asthma too. When people have both asthma and COPD, it is called overlap syndrome. It is sometimes referred to as asthma chronic obstructive pulmonary disease or ACOS for short.²

This condition is not well understood because studies tend to address either asthma or COPD, but not both together. Treatment is usually a combination of the typical treatments for both conditions.²