Ask The Advocates: What Is The Difference Between Asthma and COPD?

What is the difference between COPD and asthma? We asked our advocate team of respiratory therapists and asthma educators, and this is what they said:

Response from Theresa Cannizzarro, Respiratory Therapist:

Simply put, the difference between asthma and COPD is that asthma is classified as a reversible lung disease and COPD is classified as a chronic lung disease that is not fully reversible.

Let me explain further. Asthma is defined as a condition where your airways swell and produce extra mucus which makes breathing difficult and causes coughing, chest tightness, and oftentimes wheezing. COPD is a condition where there is chronic obstruction of airflow in the lungs that interferes with normal breathing and is not fully reversible, thus lung function decreases over time. Copd is an umbrella term that includes both chronic bronchitis and emphysema. Both asthma and copd can be managed under a doctor's care.

Response from Leon C. Lebowitz, BA, RRT:

Chronic Obstructive Pulmonary Disease (COPD) is a group of lung diseases that block airflow in the lungs. Included in this grouping are emphysema and chronic bronchitis. The blockage of airflow in the lungs makes it increasingly difficult to breathe. Many of the symptoms of COPD are similar to asthma symptoms.

Asthma is a chronic disease involving the airways in the lungs. These airways, or bronchial tubes, allow air to come in and out of the lungs. A main characteristic of asthma is that the airways are always inflamed. They become even more swollen and the muscles around the airways can tighten when something triggers the symptoms. This makes it difficult for air to move in and out of the lungs, causing symptoms such as coughing, wheezing, shortness of breath and chest tightness.

Because asthma and COPD have a number of similarities, it can be difficult to distinguish between them. However, a physician can make a differential diagnosis by taking into account the patient’s symptoms and detailed medical history, providing a thorough physical examination, and reviewing the results of medical diagnostic tests (e.g. blood work, PFT’s, x-rńys, etc.). Both COPD and asthma may cause shortness of breath and cough. A daily morning cough with mucous production is generally characteristic of COPD. Episodes of wheezing and chest tightness, especially at night, are more characteristic of asthma. The wheezing associated with asthma is considered to be reversible.

In addition, patients with asthma are more likely to have allergies such as allergic rhinitis (hay fever) or atopic dermatitis (eczema). Other common symptoms of COPD include fatigue and frequent respiratory infections. COPD is almost always associated with a long history of smoking, while asthma occurs in non-smokers as well as smokers. Smoking can also make asthma worse; and smokers are particularly likely to suffer from a combination of both asthma and COPD.

Although initially, it may take some time and effort, it is important to distinguish between COPD and asthma when the patient first presents to a physician. The treatment for each disease is completely different, even though symptoms tend to be similar. It will be of great benefit for the patient to receive an accurate diagnosis and a subsequent appropriate treatment plan. It is therefore necessary to see a competent physician who can partner with you to manage the disease.

Response from John Bottrell, RRT:

Both asthma and COPD are diseases that result in airflow limitation and shortness of breath due to airway narrowing and obstruction. However, there are a few differences between these two diseases.

  1. Asthma is caused by chronic underlying airway inflammation that worsens due to exposure to asthma triggers, resulting in airway obstruction and asthma symptoms. COPD is caused by loss of lung tissue that causes air sacs to become dilated and airways to become chronically narrowed. It is also caused by chronic airway scarring resulting in airway narrowing.
  2. Asthma is defined as being completely reversible with either time or treatment, while COPD is only partially reversible with time or treatment. This means that asthmatics have normal lung function and no (or minimal) shortness of breath between episodes, while COPDers may experience some decline in lung function and some shortness of breath between episodes, even on a good day.
  3. Asthma is most often diagnosed in childhood, and COPD most often diagnosed after the age of 40.
  4. Asthma generally does not get worse with age, although COPD gradually progresses over time. There is actually a condition called asthma/ COPD overlap syndrome, and this is where a person has a combination of both diseases. It is estimated that about 10-15% of asthmatics have this. Because it results in more severe asthma, it is sometimes defined as severe asthma.

Response from Lyn Harper, MPA, BSRT, RRT:

Since many of the symptoms are similar, it can be difficult to distinguish between COPD and asthma. Ideally, both require lung function tests to diagnosis. In the classic asthma patient, airway constriction is reversible (with or without medication), whereas the in the person with COPD, airway obstruction is largely irreversible.

COPD is term used to describe a class of pulmonary diseases such as emphysema and chronic bronchitis. It is progressive and gets worse with age. Early diagnosis is imperative to maintaining lung function. Symptoms of COPD range from increased cough and mucous production to extreme shortness of breath and exercise intolerance. In general, COPD tends to manifest itself in adults that smoke or have smoked.

Asthma is characterized by bronchoconstriction that causes wheezing, airway inflammation, and hyper-sensitive airways. This, in turn, leads to coughing and shortness of breath. Asthma is noted for its intermittent symptoms that can be triggered by allergens, weather (both hot and cold), and exercise. The initial presentation of asthma is usually much younger than the onset of COPD.

Both tend to respond well to medications for the lungs, particularly bronchodilators and long term corticosteroids. With both conditions it’s very important to quit smoking and avoid any pollutants that irritate the lungs.

Response from Lorene Alba, AE-C:

Both asthma and COPD are diseases of the airway that make it hard to breathe. They have similar symptoms; such as shortness of breath and coughing. Both are chronic. However, they are very different diseases. Asthma symptoms are caused when you breathe in a trigger. These symptoms can be “reversed” with medication. When you have chronic bronchitis or emphysema, the two diseases under the umbrella of COPD, the symptoms can be lessened, but not reversed.

Why? Because COPD means there is permanent damage or scarring to the lungs. However, asthma is episodic, meaning symptoms come and go. COPD is a progressive lung disease that worsens over time due to structural changes, or damage, to the airways. Triggers can also cause acute symptoms if you have COPD. It’s possible to have asthma-COPD overlap syndrome, when you have both diseases. Ask your health care provider for lung function testing to get the correct diagnosis and treatment plan.

Editor's Note: The information in this article cannot be substituted for medical advice. Always consult your doctor before beginning, ending, or changing treatments.

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