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COPD vs Asthma: Everything You Need to Know

Feb 28, 2018 5:31:12 AM / by Duke Reeves

Asthma and COPD are often confused, but they are two very different diseases. Even though they both cause similar respiratory symptoms, they affect the lungs in distinct and different ways.


COPD is an age-related disease that usually affects smokers and people with long-term exposure to toxins that damage their lungs. Asthma, on the other hand, is often inherited and affects children, teens, and adults of all ages.


Understanding the differences between these two respiratory conditions is important for adults who experience chronic respiratory symptoms, especially if they have already been diagnosed with asthma. While asthma and COPD are separate conditions, in some cases, asthma can cause or contribute to COPD.


COPD is one of the most under-diagnosed and commonly mis-diagnosed diseases, so it's important for doctors and patients alike to be knowledgeable about what sets it apart. That's why, in this article, we're going to show you how to recognize and distinguish the differences between asthma and COPD.

 

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Asthma Versus COPD

Illustration of the various arteries extending from the lungs.


It is difficult to tell asthma and COPD apart by symptoms alone. Serious symptoms like coughing and difficulty breathing can be caused by asthma, COPD, or a combination of both at the same time.


Here are some of the symptoms that asthma and COPD share:

  • Coughing
  • Wheezing
  • Shortness of breath
  • Rapid breathing
  • Bronchial spasms
  • Chest tightness and discomfort


Despite their similarities, from a medical standpoint, it's vital to be able to tell the two diseases apart. Both asthma and COPD require different medical approaches and respond to different treatments and medications.


Moreover, in some cases, people with asthma are actually more prone to developing COPD later in life. Studies show that about forty percent of people with COPD also have asthma, so it's vital for patients to understand the relationship between the two conditions.


In this next section we're going to help you do just that by explaining the causes and symptoms of asthma and COPD. Next, we'll break down the many differences between asthma and COPD and explain the characteristics that distinguish them from one another.


By the end of this article, you'll have a much better understanding of how the diseases are similar and different and be better able to tell the two conditions apart.


Understanding COPD

 

Bronchitis and emphysema usually result from smoking.


COPD can be a difficult disease to understand, partially because it is an umbrella term that encompasses two separate but related conditions: emphysema and chronic bronchitis. Both are chronic, incurable lung conditions, usually caused by smoking.


Emphysema occurs when the air sacs (alveoli) in the lungs get damaged, causing lung function decline and over-inflation in the lungs. People with emphysema have difficulty absorbing enough oxygen and pushing all of the air out of their lungs.


Chronic bronchitis occurs when the airways become inflamed, thickened, and narrowed due to inflammation and excess mucus. Most people with COPD have some combination of both emphysema and chronic bronchitis.


Both chronic bronchitis and emphysema cause similar symptoms that get worse and worse over time. While proper treatment and a healthy lifestyle can slow down disease progression, they can't stop COPD from inevitably getting worse.


Over time, COPD leads to more serious complications like pulmonary hypertension, heart failure, respiratory failure, and death. But with a healthy lifestyle and high-quality medical treatment, many people with COPD are able to live and stay active for many years.


Common Symptoms of COPD:

  • Coughing
  • Wheezing
  • Chest Tightness
  • Shortness of breath
  • Thick or excess mucus
  • A chronic cough that produces phlegm (especially in the morning)
  • Frequent respiratory illnesses and infections
  • Fatigue
  • Unintended weight loss
  • Swelling in hand, ankles, feet, and legs (edema)


Understanding Asthma


Unlike COPD, which usually shows up later in life, asthma can be inherited and often shows up in early childhood. Most people discover they have asthma after they experience an exacerbation, often in reaction to an allergen or respiratory infection.


People with asthma don't have symptoms all the time. Asthma symptoms usually only show up in response to an environmental trigger, which is often pollen, smoke, or cold air. Because of this, asthma is often considered to be an allergic disorder.


When someone with asthma is affected by a trigger, it causes the muscles in their lungs and airways to violently constrict in an attempt to keep irritating molecules out. This causes a fit of coughing and wheezing that often requires medication to stop.


Asthma attacks can be life-threatening if not treated quickly. Most of the time, treatment involves inhaling bronchodilators and corticosteroids to control inflammation.

 

Illustration showing the lungs before and after an asthma episode.


Common Symptoms of Asthma:

  • Coughing
  • Wheezing
  • Shortness of breath
  • Chest pain and tightness
  • “Asthma attacks” consisting of coughing and wheezing that are worsened by illnesses and allergies


How to Tell Asthma and COPD Apart

 

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Differences in Age of Onset

 

Boy using an AeroChamber Flow-Vu device to alleviate asthma symptoms.


Many people first start to show symptoms of asthma in early childhood and get diagnosed with the disease at an early age. Some people grow out of their asthma symptoms, but many people continue to have the condition throughout their adult life.


COPD, on the other hand, is an acquired disease that doesn't show up until later in life. It's a result of cumulative damage to the lungs and airways over many years, and is usually diagnosed after the age of forty.


Symptoms are usually mild in the early stages of COPD, but get more and more severe with time. In the later stages of the disease, people with COPD usually exhibit severe respiratory decline and need supplemental oxygen to breathe.


While asthma symptoms might be exacerbated by allergies and other triggers for short periods of time, the symptoms don't usually get worse with time. In-between exacerbations the symptoms usually disappear, and the disease doesn't usually progress into anything more serious.


Differences in Causes

 

Cigarette box with warnings on the side.


COPD is usually caused by exposure to smoke, pollution, and other substances that damage your lungs.  In fact, about 90% of COPD cases are caused by smoking tobacco.


Common Causes of COPD:

  • Smoking cigarettes and other forms of tobacco

  • Long-term exposure to other sources of smoke, including wood-burning stoves, cooking fumes, and secondhand smoke.

  • Long-term exposure to respiratory irritants like bacteria, mold, and chemical fumes (e.g. in the workplace).

  • Exposure to respiratory toxins like asbestos and radon

  • Alpha-1 Antitrypsin Disorder, a genetic disease that causes thickened mucus in the lungs, airways, and other parts of the body.


The causes of asthma, on the other hand, are not as well understood. Like COPD, asthma can result from lung damage due to exposure to respiratory toxins. However, this is actually the least common cause.


Asthma is much more likely to show up early in life, before the lungs have a chance to accumulate any serious damage. Instead, asthma is more likely to be the result of genetics, early childhood respiratory infections, or allergies.


Common Causes of Asthma:

  • Genetic-linked Asthma: Asthma linked to a family history of asthma and other allergic disorders like hay fever and eczema

  • Illness-induced Asthma: Asthma caused by recurrent respiratory infections or serious lung infections early in life

  • Allergy-induced Asthma: Asthma caused by airborne irritants and allergens like pollen, mold spores, dust mites, and pet dander

  • Occupational Asthma: Asthma caused by long-term occupational exposure to smoke, dust, or chemical fumes and gases


Differences in Symptoms

 

Woman coughing into her hand.


As you can see, asthma and COPD symptoms can seem very similar on the surface. However, if you pay closer attention to these symptoms and when they occur, you can better tell the difference between the two diseases.


For example, the most common symptoms of both asthma and COPD are coughing, wheezing, and difficulty breathing. These symptoms tend to show up early on in both diseases, but the frequency of these symptoms differs between the two.


People with asthma tend to only show symptoms when they're triggered by an exacerbation. Once the exacerbation has been treated with medication, the symptoms usually disappear.


People with COPD tend to experience chronic symptoms that don't ever completely go away. While certain triggers and exacerbations can make their symptoms much worse, COPD patients generally face milder symptoms of coughing and breathlessness every day.


Another difference is in the nature of the cough. Asthma tends to cause a dry cough that comes with bouts of breathlessness and wheezing, while COPD tends to cause a wet, phlegm cough that appears every day, independent of breathing difficulties.


Differences in Triggers

 

Purple flower excreting pollen, one common outdoor irritant for both asthma and COPD patients.


Besides examining potential causes and specific symptoms, another way to tell asthma and COPD apart is by their triggers. Some of the triggers for worsened asthma and COPD symptoms are the same, but some are unique.


As we've mentioned, asthma symptoms tend to be severe and show up in response to weather, allergens, and heavy physical activity. COPD symptoms, on the other hand, are chronic and milder, although exposure to extreme weather, exercise, allergens, and other respiratory irritants can worsen symptoms to a degree.


However, these irritants usually only trigger slightly worsened coughing and breathlessness in people with COPD, not an actual exacerbation. True exacerbations are much more serious and are usually only caused by respiratory illnesses and infections.


Severe asthma exacerbations, on the other hand, can be easily triggered by minor environmental irritants like cold air and pollen.


Common Triggers for Asthma Exacerbations:

  • Allergens
  • Exercise
  • Cold air


Common Triggers for COPD Exacerbations:

  • Respiratory infections
  • Respiratory illnesses like the cold, flu, or pneumonia
  • Exposure to pollutants and lung irritants


By paying attention to what activities and environments cause your symptoms to act up, you can often determine whether asthma or COPD is the more likely culprit. Keep a look out for distinguishing triggers and make sure to report any new symptoms or sensitivities to your doctor as they come up.


Asthma Can Increase Your Risk for COPD

 

It's a two-way road when it comes to asthma and COPD.


Despite being distinct and separate diseases, in some cases asthma and COPD are intimately related. Studies show that up to forty percent of people with COPD also have asthma, which indicates that people with asthma are at a much higher risk for the disease.


Doctors and researchers aren't quite sure what might cause people with asthma to develop COPD (known as asthma-COPD overlap syndrome), but it might have to do with the chronic respiratory inflammation that asthma causes. Severe, untreated asthma, researchers postulate, might cause changes in the lungs and airways that reduce lung function over time.


If their lung function has already been affected, people with severe, untreated asthma may be even more prone to developing COPD. This is especially true if they smoke or are exposed to other respiratory irritants over a long period of time.


To the best of medical knowledge, the best way to prevent asthma-related COPD is early asthma treatment and symptom management. Asthma patients who are diagnosed early and get medicine to treat their symptoms usually don't experience complications later in life.


Diagnosing COPD

 

Illustration depicting a spirometry test, used to test the function of your lungs.


COPD symptoms tend to show up later in life, usually after the age of forty. Symptoms often start with coughing and breathlessness during exercise, which prompts many patients to visit their doctor to determine the cause.


The doctor will then do a general physical exam and test the patient's lungs. To do this, doctors use a special lung test called a spirometry test.


To do this simple test, the patient takes a deep breath and then blows as hard as they can into a spirometer. Based on the spirometer's score, the doctor can tell how much the patient's lung function has declined, if at all.


Based on the spirometry results, the physical exam, and the patient's age and smoking history, the doctor will determine whether COPD is an accurate diagnosis. If the patient is over forty, has decreased lung function, and is a current or former smoker, COPD is very likely.


Unlike asthma, COPD does not respond completely to treatment with medications like steroids and bronchodilators. An asthma patient's lung function tends to return to normal after treatment, whereas COPD patients experience a permanent loss in lung function that cannot be restored with medications.

 

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While COPD symptoms can be treated with medicine, they never quite go away completely. The damage that the lungs have already sustained can never be undone.


Diagnosing Asthma

 

Woman being tested for asthma by a specialist.


Asthma symptoms often show up by the age of five, starting with bouts of wheezing and dry coughing. These ailments usually prompt a visit to the doctor, who does a general physical exam and listens to the patient's lungs for wheezing and abnormalities.


The doctor will note any allergies the patient has along with any additional respiratory symptoms.  Doctors also use spirometry tests to check overall lung function in suspected asthma patients.


If asthma is suspected, the doctor will then prescribe an inhaled bronchodilator medication (inhaler) for the patient to use if the symptoms show up again. If the patient responds well to the medication and the symptoms disappear quickly after using their inhaler, the doctor will usually diagnose the patient with asthma.


Medical Treatments for Asthma and COPD

 

Inhalers are commonly used to treat asthma symptoms.


Treatment approaches to asthma and COPD are both similar and different. Asthma treatment focuses on using medication to treat asthma symptoms exacerbations when they come. COPD treatment, on the other hand, tend to focus on exercise, diet, and lifestyle changes that can strengthen the lungs and prevent further respiratory decline.


Bronchodilators are a type of inhaled medication used to reduce coughing and wheezing by opening up the airways and making it easier to breathe. Both people with asthma and people with COPD use bronchodilator medications to treat immediate respiratory symptoms, and it's a primary method of treatment for COPD.


People with asthma usually also take inhaled corticosteroid medications on a regular basis to help manage inflammation and prevent exacerbations. While COPD patients sometimes take corticosteroids as well, it's not as common for long-term treatment.


As the disease progresses, people with COPD often end up needing to use supplemental oxygen therapy in order for their lungs to absorb enough oxygen to meet their body's needs. This is rarely needed for people with asthma except in the midst of a severe exacerbation. This is because asthmatic lungs are generally healthy and able to absorb enough oxygen on their own in normal circumstances.


In the latest stages of the disease, some COPD patients are eligible for lung reduction surgery or lung transplant surgery. These are last-resort measures that are usually only used if a patient is unable to survive on their own without them.


Lifestyle Treatments for Asthma and COPD

 

Man refusing a cigarette.


Treating asthma usually doesn't require any major lifestyle changes besides not smoking and avoiding respiratory irritants. Asthma patients focus mainly on controlling inflammation and preventing exposure to triggers that result in exacerbations.


COPD, on the other hand, requires a myriad of lifestyle changes and a tailored treatment plan. The most important thing to do is to quit smoking, but after that a healthy diet, exercise, and medications take priority. Although continued respiratory decline is inevitable for most people with COPD, these lifestyle changes can slow down the disease's progression and improve their ability to breathe.


Obviously, people with asthma can benefit from a healthy diet and lifestyle, too. Both people with asthma and COPD should never smoke, stay physically active, and eat a balanced diet full of fruits, veggies, and lean protein.


Staying hydrated is also very important for managing a respiratory illness like asthma or COPD. Water thins out the mucus in your airways, making it easier to breathe, and keeps the rest of your body's functions running efficiently.


Exercise is also very important, but especially for people with COPD. People with asthma should get plenty of physical activity too, but for people with COPD it is vital to prevent further physical and respiratory decline.


Disease Outlook for Asthma and COPD

 

Man in hospital bed being treated for a lung condition.


People with asthma generally only have to worry about avoiding their triggers and treating inflammation with medication. While poor lifestyle choices like smoking and exposure to respiratory irritants can sometimes make asthma worse, most people with asthma live healthy lives and experience no decrease in lifespan.


COPD, on the other hand, tends to slowly worsen over time no matter how well it's treated. Quitting smoking and building healthier habits can improve your lifespan and quality of life, but it cannot prevent the disease from continuing to progress.


However, many people with COPD are able to live good, fulfilling lives in spite of their disease. This depends partially on an early diagnosis, but primarily on how well you comply with your COPD treatment plan.


How much physical activity you get, how well you manage your symptoms, and how well you practice other healthy lifestyle and diet habits can have a major effect on your body's strength and ability to cope with the disease.


Conclusion


If you are an adult with worrisome respiratory symptoms, it can be difficult to get an accurate diagnosis. One reason for this is the fact that both asthma and COPD share identical symptoms and sometimes share a common cause.


Both asthma and COPD are relatively common diseases, which makes it all the more important for more people to be able to recognize and seek treatment for both. The relationship between the two conditions can be complicated, and it's important for patients and their loved ones to be aware.


Now that you've learned more about the two diseases, you will be better equipped to help yourself, your friends, and your loved ones get proper diagnosis and treatment for their respiratory symptoms. While you should always defer to a doctor for a final diagnosis, this knowledge is vital to help the estimated thirteen million people with COPD who are still un-diagnosed get the medical attention they need.


While neither disease can be cured, the symptoms of asthma and COPD can be reduced and controlled with the right kind of care. The earlier someone with asthma or COPD gets an accurate diagnosis and begins treating their disease, the easier it is to stay healthy and maintain a good quality of life.

Topics: COPD, Respiratory Resource Center, asthma

Duke Reeves

Written by Duke Reeves

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