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Differences Between Asthma and COPD

Asthma and COPD are similar in many ways. They are also different in many ways. Here is a list of the differences between asthma and COPD.

  • Years ago, asthma was an umbrella term under which all lung diseases fell, including COPD. Today, asthma is no longer considered an umbrella term.
  • Today, asthma is a disease entity on its own. And, as a twist, COPD is now considered an umbrella term. The two most common diseases that fall under the umbrella of COPD are chronic bronchitis and emphysema.
  • COPD is never asthma. But, sometimes asthma can become COPD.
  • Asthmatics only experience symptoms during asthma attacks. People living with COPD may experience some symptoms even on good COPD days.1
  • When people living with asthma experience symptoms they are generally referred to as asthma attacks. When people living with COPD experience new or worsening symptoms they are generally referred to as COPD flare-ups.
  • Asthma symptoms are completely or almost completely reversible with time or treatment. COPD symptoms are only partially reversible or not reversible at all.1
  • Asthma symptoms only occur during asthma attacks. COPD symptoms may be present to some degree all the time.
  • Asthma is usually considered a periodic disease. This means symptoms only occur sometimes. COPD is usually considered a persistent disease. This means that symptoms may appear to some degree all the time.
  • Periods between asthma attacks may last days, weeks, months, or even years. In this way, asthma can seem to go into remission in some people. COPD flare-ups may also be periodic in this way. But, COPD does not go into remission.
  • Asthma usually does not progress over time. COPD is generally considered a progressive disease. But, this progression may be slowed (sometimes significantly) with a proper diagnosis and aggressive treatment.
  • Speaking of diagnosis, both diseases may be confirmed with a test called a pulmonary function test (PFT). The test will show if triggers cause airflow limitation. It can also show if this airflow limitation is reversible (indicating asthma) or not reversible (indicating COPD).
  • Asthma medicines are used to prevent and control asthma symptoms. COPD medicines are used to allay symptoms and slow the progression of the disease.
  • There are two types of immune cells that cause airway inflammation: eosinophils and neutrophils. Both may be present in asthma and COPD. But, asthmatic inflammation is usually associated with eosinophils and COPD inflammation is usually associated with neutrophils.3,4
  • Asthmatic inflammation responds well to corticosteroids and beta 2 adrenergic bronchodilators like albuterol (Ventolinn, ProAir). COPD inflammation responds less well to corticosteroids (although it may respond to some degree). It may respond to bronchodilators like albuterol. But, some studies show it responds better to muscarinic antagonist bronchodialtors like ipatropium bromide (Atrovent) and tiotropium bromide (Spiriva).
  • Asthma inflammation makes airways hypersensitive (twitchy) to asthma triggers. Exposure to triggers makes this inflammation worse. This is what causes asthma symptoms and asthma attacks. Hyperactive airways may cause some COPD flare-ups. But, there are various other components of COPD that may also cause flare-ups.3
  • Therefore, asthma can be prevented and controlled with a daily regimen of inhaled steroids and long-acting bronchodilators. Similar medicines can allay symptoms and slow the progression of COPD.
  • Asthma attacks can be reversed using bronchodilators. Persistent attacks can be reversed with small doses of systemic corticosteroids. COPD flare-ups may be partially reversed with bronchodilators and systemic corticosteroids.
  • They both respond to inhaler and nebulizer medications. These include bronchodilators and corticosteroids.
  • Asthma generally does not require equipment other than inhalers and nebulizers. COPD may require other equipment, such as oxygen supplies, and machines such as CPAP and BiPAP.
  • Asthma tends to be caused by asthma genes. So, it tends to be unpreventable. COPD is usually caused by long-term exposure to noxious substances that are inhaled. So, it is often considered preventable disease.
  • There are over 100 genes known to cause asthma. There is only one gene known to cause COPD. This gene may cause a rare form of COPD called alpha-1 antitrypsin deficiency. This is often referred to as genetic COPD.
  • Therefore, most cases of asthma are said to be hereditary or genetic. At the present time, only 5% of people with COPD have genetic COPD. This means they develop it regardless of exposure to noxious substances in the air.2
  • Asthma can be diagnosed at any time in a person’s life. COPD is usually not diagnosed until after the age of 40 or 45.

What to make of this

So, there are many similarities between asthma and COPD. There are also many differences, as shown by this list.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Asthma.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. “Links between asthma and COPD,” American Lung Association,” https://www.lung.org/local-content/illinois/documents/the-link-between-asthma-nov-2013.pdf, accessed 3/27/19
  2. Weinberger, Cockrill, Mandel, editors, “Principles of Pulmonary Medicine,” 6th Edition, 2014, Elsevier
  3. Kacmarek, Stoller, Heuer, editors, “Egans: Fundamentals Of Respiratory Care,” 10th Edition, 2013, Elsevier
  4. Huang, et al, “Neutrophilic Inflammation in the Immune Responses of Chronic Obstructive Pulmonary Disease: Lessons from Animal Models,” Journal Of Immunology Research, 2017, April 23, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426078/, accessed 4/16/19
  5. Fahy, John V., “Eosinophilic and Neutrophilic Inflammation in Asthma: Insights from Clinical Studies,” ATS Journals, 2008, August 19, https://www.atsjournals.org/doi/full/10.1513/pats.200808-087RM, accessed 3/28/19

Comments

  • sashabear
    6 months ago

    “Asthmatics only experience symptoms during asthma attacks. ”

    I don’t get this at all. It is a pervasive opinion throughout the article. I do NOT have COPD. Been through every possible test. I workout every day, but ALWAYS know I have asthma, and ALWAYS have symptoms unless I use my medication. I feel chest tightness, shortness of breath, etc.

    This article for me diminishes the daily impact of asthma. I am waiting for assistance with FASENRA that will hopefully help me. My social life is dependent on a nebulizer. When I need the nebulizer several times a day, is that an “asthma attack”???

  • Leon Lebowitz, RRT moderator
    6 months ago

    Hi sashabear and thanks for your comments in response to John’s article. Although I cannot presume to answer for John (and I’m sure he will comment once he sees yours), the prevailing thought when it comes to asthma is that, between attacks, one should be considered to be ‘symptom free’. We understand that for many people with asthma, they do not feel that is the case. In the most general of terms, if someone with asthma has symptoms all the time, the condition is not adequately controlled. This often times requires a lot of collaborative work between the patient and the doctor in adjusting the medication regimen to treat asthma properly and effectively. Does this seem to apply to your situation? Leon (site moderator)

  • Sumra Alvi moderator
    6 months ago

    Hi sashabear, I hear you and can understand why that sentence in particular really diminishes the daily impact of asthma! Do you want to talk to me more about how your asthma has impacted your social life? I know you must be feeling frustrated so please feel free to share more with me if you want to. Really appreciate your feedback on this piece, we’re always trying to learn more about our community members and provide resources that reflect their experiences. You’re not alone and I’m here to listen! Warmly, Sumra (Asthma.net Team)

  • cali
    6 months ago

    Thank you for writing this! I’m 69 years old and so confused! I was born/raised in So CA (some allergies) and diagnosed with asthma 38 years ago after my husband and I moved to NE OH – typical ER visits but managed for the most part with a rescue inhaler. We moved to a farm area 12 years ago and I had lots of sneezing and wheezing. I also became a long-distance caregiver for my parents around the same time and my symptoms would improve while in CA and worsen in OH. I was hospitalized in early 2017 with pneumonia and sepsis; spent about 5 months back and forth in caregiving and crashed after my last return to OH in Oct. I spent 6 months under the care of a specialist who did allergy testing (4+ on a 1-4 scale on basically everything); initial FEV1 of 26 on spirometry – improvement with b/t; normal echocardiogram. I took steroids, used a nebulizer, slept for weeks and felt worse. After months of treatment my PFT showed lung function at 25%, very severe obstructive disease, and my doctor suggested the Cleveland Clinic. I started acupuncture treatments instead but within two months my mom had an emergency and my husband had to take me to CA (wheelchair). Within three weeks of being in there my breathing improved to the point that I ended up staying to be her caregiver! I continue acupuncture and have established the appropriate medical providers; just had a CT scan and PFT (FEV1 at 32 – improvement with albuterol). So, here’s my confusion. OH specialist said I have severe asthma that is probably caused by acid reflux (although I’ve never had symptoms); CA allergist/immunologist said I have vocal chord dysfunction; CA specialist refers to obstructive disease as COPD/asthma and wants to put me on Spiriva (about $450/month!). I just want to know what I actually do have…..my breathing is entirely different in CA than it was in OH. I use one puff of albuterol every 3-4 hours (I know, but it’s what works) and sleep 7-9 hours without needing it. I have immediate reactions to triggers (strong scents, smoke, humidity, etc); low energy and little stamina but try to walk for exercise. One year ago I felt like I was dying……now I take care of my mom. But, so confused!

  • John Bottrell, RRT moderator author
    6 months ago

    Hi. Glad you enjoyed the article. Thank you for sharing your story. It certainly sounds like you’ve been through the ringer. It certainly can be confusing when you have different doctors telling you different things. Are any of the doctors you are seeing asthma specialists, such as a pulmonologist or an immunologist? I would think one of these doctors would be able to interpret your pulmonary function test to let you know if you have asthma and/or COPD and how severe it is. That might be a good place to start. Does this help? John. Site Moderator.

  • John Bottrell, RRT moderator author
    6 months ago

    Hi. Cali. No problem at all. I could give you my guess what your doctor’s mean by “severe obstructive disease.” But I think it would be best to ask one of those doctors what they mean. That might even spearhead a conversation that might help you better understand your condition and what the best treatments are for helping you. Do keep us posted what you learn. John. Site Moderator.

  • cali
    6 months ago

    Thank you for wading through my million words! The doctors in OH and CA are both pulmonary specialists. Severe obstructive disease is the common comment. Is that perhaps a new umbrella term?

  • Shellzoo
    6 months ago

    Oh, I would like to read about that hazy area between COPD and asthma. I wonder if someday it will have it’s own diagnosis.

  • John Bottrell, RRT moderator author
    6 months ago

    Oops. I meant to attach the link to it, but the link I put on there is to a Youtube channel my son likes. lol. Here’s the link I meant to attach. Here’s the article. John. Site Moderator. https://copd.net/living/has-asthma-progressed/

  • Shellzoo
    6 months ago

    That was a great read! Last year I went in for my asthma follow-up appointment after being treated with Adair 500-50 over a month. I felt great, was breathing great. I figured I would be told the asthma diagnosis was a mistake and I am just out of shape. I was given another spirometry test and my physician comes in shaking his head, throws a sample of Incruse Elipta in my hands and says he thinks due to my allergies that I always have “chronic inflammation” in my airway. I of course felt denial and blurted out that I don’t have COPD because I never smoked and always had healthy lungs (forgetting about episodes throughout my life). He then told me his goal is to keep my lung function above 40-60%. I was in denial even though I really did understand what he was saying. At my next appointment my spirometry was tested, then following the neb treatment and it essentially was the same result going up from 74% to 76%. The PA that I saw was frustrated about it, said they needed to check into other things and I was tested for genetic COPD which I don’t have. Since then, my doctor has not said I have COPD, only that I have asthma but I am on the COPD dose of Spiriva because I did not tolerate Incruse Ellipta. So, I am reading between the lines and figure I am in that hazy area between COPD and Asthma. My encouragement is at my last check I got my spirometry result up to 79% even though I thought I would pass out trying. With good treatment I have made it my goal to keep my airway as healthy as possible and hopefully have more improvement. Thanks for your articles. I feel there must be more of us walking the Asthma/COPD tightrope and hope there will be more articles about it.

  • Shellzoo
    6 months ago

    I think I am stuck in that hazy area between asthma and COPD. I know my doctor very clearly said I have asthma. He thinks my airway always has some inflammation. My spirometry last was 79% which was up from 74% after being on Spiriva Respimat. I know my Spiriva dose is the COPD dose. I was tested for genetic COPD after I showed minimal improvement on my spirometry following a neb treatment. When I asked if I had COPD I was told they think I have actually had asthma for a long time and thus have permanent changes to my airway. Last I knew my asthma was listed as moderate persistent on my bill. This was a great article explaining the difference but I do feel there is that hazy asthma/COPD and wonder how common it is….

  • John Bottrell, RRT moderator author
    6 months ago

    Neat you use the word “hazy” in reference to that line between asthma and COPD. That’s how an ER doctor explained my asthma to me last month. I actually even wrote about it if you’re interested. Personally, and I know we aren’t supposed to diagnose (so I will use the word think) — I think a FEV1 of less than 80% between asthma attacks qualifies for a COPD diagnosis. I wonder if that would get you better reimbursement or your medicines. John. Author/ Site Moderator. https://youtu.be/iPl_ph19WsY

  • Shellzoo
    6 months ago

    I see the PA at my doctor’s office in a few weeks and am going to ask that question then. I sorta got that impression myself but again, we don’t diagnose. Just working in the medical field, we usually have a better understanding of systems and terminology. Last time I asked I think they suspected some remodeling.

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