Understanding the Difference Between Asthma and COPD

Asthma and chronic obstructive pulmonary disease (COPD) both cause breathing problems. Both conditions are characterized by cough, shortness of breath and airflow limitation. But each requires a unique approach to care.

If you have trouble breathing, getting the right diagnosis is essential. Pulmonologist (lung specialist) Sobia Farooq, MD, explains the differences between asthma and COPD.

How do you know if you have asthma or COPD?

A healthcare provider can help you determine if you have asthma or COPD. “Sometimes, the difference is clear,” says Dr. Farooq. “People with COPD are typically over age 40 and have a history of smoking. For someone under age 40 who has never smoked, asthma is the more common diagnosis.”

But several factors can blur the line between asthma and COPD:

• About one-third of people with COPD have never smoked.
• Asthma can appear later in life.
• Asthma and COPD can occur together.

Symptoms of asthma vs. COPD

The main symptoms of asthma and COPD include:

• Cough.
• Shortness of breath.
• Wheezing.

Asthma symptoms typically appear as attacks (exacerbations), ranging from mild to severe. Between attacks, you may not have any breathing difficulties. Common triggers of asthma attacks include:

• Allergies.
• Cold air.
• Exercise.
• Respiratory tract infections.
• Tobacco smoke.
• Stress.

In COPD, you typically have symptoms all the time. But exacerbations can also occur. They often require hospitalization and may cause further lung damage, says Dr. Farooq. The most common triggers of COPD exacerbations are respiratory tract infections.

Diagnosis: Is it asthma or COPD?

When two diseases are so alike, getting the right diagnosis requires careful attention to detail. According to Dr. Farooq, providers diagnose asthma and COPD based on:

• History: Your history of smoking and exposure to secondary tobacco smoke and other air pollutants at home or work. Plus, your family and medical history.
• Symptoms: The patterns and types of symptoms you are having and how they affect your daily life.
• Tests: Physical exam to hear how your lungs sound, plus tests such as X-ray imaging and pulmonary function tests (PFTs).

Spirometry is the most readily available and useful lung function test. During the test, you take a deep breath in and a deep breath out. The test measures the volume of air exhaled at specific moments during your exhale. Your provider does a spirometry test to get a baseline measurement. Then, they can test how you respond to different medications:

• Bronchodilator reversal test: Bronchodilators open your airways. If you have asthma, the medication should improve your spirometry measurements, which isn’t always the case with COPD.
• Methacholine challenge test: Methacholine narrows your airways if you have asthma. In a challenge test, you receive a small dose of methacholine. A lower spirometry score suggests you have asthma.

How often is COPD misdiagnosed as asthma?

Because asthma and COPD are so similar, providers may misdiagnose them. One study noted the importance of pulmonary function testing in making an accurate diagnosis. The researchers found that when providers didn’t use PFT, more than one-third of asthma and COPD diagnoses were incorrect.

Causes of asthma vs. COPD

Healthcare providers aren’t sure why some people develop asthma as children or adults. “It’s likely due to a combination of genetics and environmental exposures,” says Dr. Farooq. “People with a history of allergies and or family history of asthma have a higher asthma risk.”

The main cause of COPD is smoking, although you can have COPD even if you never smoked. Other possible causes include:

• Breathing in harmful chemicals and particles in the air at home, work or outdoors.
• An inherited condition called alpha-1 antitrypsin deficiency, which can cause both lung and liver damage.

Treatments for asthma and COPD

There are several common treatment strategies for asthma and COPD. Quitting smoking is one of the most important.

“Patients with COPD often ask if there’s a benefit to quitting smoking,” says Dr. Farooq. “The answer is ‘yes.’ When you quit smoking, your lungs’ natural defensive mechanisms come back, which can protect you from lung infections. Quitting smoking also slows down the decline in lung function and progression of COPD.”

It’s also important to avoid known triggers of asthma and COPD exacerbations and take steps to prevent respiratory tract illnesses.

Specific treatments for asthma and COPD include:

Asthma treatment

Asthma treatment usually includes one or more medications, depending on how severe your asthma is. Healthcare providers start with short-acting bronchodilators (rescue inhalers). If you’re still having symptoms, your provider may add in other medications, such as:

• Inhaled corticosteroids.
• Long-acting bronchodilators.
• Oral steroids or injected medications (for severe persistent asthma).

Avoiding triggers is also a very important part of managing asthma. Whether your triggers are environmental, pet dander, tobacco smoke, mold, pollution or others, it’s important to identify and avoid your triggers in order to manage your asthma.

COPD treatment

Long-acting bronchodilators are the first-line treatment for COPD, often in combination with a short-acting bronchodilator. Your provider may also prescribe oral medications to help prevent COPD exacerbations.

Dr. Farooq recommends additional steps to help manage COPD:

• Avoid smoke: If you smoke, quitting is one of the best things you can do to manage your COPD. Avoiding cigarette smoke from others is also important.
• Get your immunizations: Stay up to date on all vaccinations, especially for the flu, pneumonia and COVID-19.
• Eat a healthy diet: Healthy foods can give you strength and energy and help prevent muscle loss (sarcopenia) that often occurs with COPD.
• Increase physical activity: Exercise can help reduce COPD symptoms. Pulmonary rehabilitation is a structured program that provides a personalized exercise plan, education and support.
• Manage other health conditions: Sleep apnea, heart disease and mental health conditions increase your risk of COPD exacerbations. Managing these conditions can help lower this risk.

Does asthma ever turn into COPD?

You may have a higher chance of developing COPD if you have unmanaged, untreated asthma. “This is especially true if you didn’t receive proper asthma treatment over a substantial period of time, which can lead to changes in your airways,” explains Dr. Farooq.

It’s also possible to have both asthma and COPD, a condition called asthma-COPD overlap (ACO). If you have ACO, your treatment plan will include medications for both conditions.

Which is more serious: asthma or COPD?

Asthma and COPD can both be serious, and neither has a cure. But with your healthcare team’s guidance, you can manage these conditions. Follow your recommended treatment plan to help you avoid exacerbations and live a healthier life.