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COPD vs. Asthma: What’s the Difference?

Medically reviewed by Angelica Balingit, M.D.
Posted on August 30, 2023

If you’re living with chronic obstructive pulmonary disease (COPD) and asthma, you may be wondering which symptoms are from which condition. COPD and asthma are lung diseases that block airflow in the lungs, leading to similar symptoms. It can be tricky to figure out how to manage both conditions at the same time. In this article, we’ll describe the similarities and differences between COPD and asthma, including causes, diagnosis, symptoms, and treatment.

Similarities Between COPD and Asthma

It’s easy to confuse COPD and asthma because of their many similarities. They are diagnosed in similar ways, have similar signs and symptoms, and are treated with many of the same drugs.

Diagnosis

Both asthma and COPD are diagnosed with a combination of medical history and physical exam. For a COPD diagnosis, your doctor may ask you questions related to your history of exposure to cigarette smoke, environmental exposures, family history, and symptoms. For an asthma diagnosis, your doctor will be especially interested in your family history of asthma and reaction to common allergens, whether you have eczema, and if you have other lung diseases such as COPD.

In a physical exam, your doctor will listen to your lungs and heart and take your blood pressure. If they suspect that you have COPD, they will check for swelling in your feet and ankles.

Then, your doctor may use a test called spirometry to measure the function of your lungs by how much air you can breathe in and out and how quickly you can do it. Spirometry is a test that helps doctors tell the difference between asthma and COPD. For COPD, doctors use spirometry to make an official diagnosis. On the other hand, asthma can be diagnosed by a doctor based on symptoms or through different tests like spirometry, peak flow, bronchoprovocation (a test that helps doctors assess how sensitive a person’s airways are to certain triggers), or nitric oxide tests. Other simple tests, such as chest X-ray, pulse oximetry, and exercise tests, can help determine how severe your asthma or COPD is.

Symptoms

The signs and symptoms of COPD overlap with the symptoms of asthma. Similar symptoms between the two conditions include:

  • Chest tightness
  • Wheezing, especially when exhaling
  • Worsening of symptoms due to respiratory infections
  • Shortness of breath, especially while sleeping, exercising, or after exposure to smoke or fumes

In addition, COPD usually causes a cough with phlegm (mucus) that doesn’t go away, is usually worse in the morning, causes severe shortness of breath during everyday activity, and leads to swelling of the feet and ankles.

Management

Treatment options for COPD and asthma have a lot of overlap. COPD is treated by relieving symptoms and avoiding infection. To help with coughing and breathing issues, your doctor could suggest bronchodilators that make it easier to breathe by widening your lung airways. They might also recommend anticholinergics to open and relax these airways, and anti-inflammatory medicine (inhaled corticosteroids) to lower lung inflammation. If necessary, your doctor might provide supplemental oxygen, given to you through a nasal tube or mask, to make sure your blood has enough oxygen. To prevent infections, your doctor might suggest getting vaccinated against common respiratory illnesses like the flu and COVID-19. They may also recommend taking antibiotics to treat bacterial infections if needed.

The goal of asthma management is to have few or no asthma symptoms. Asthma, just like COPD, can’t be cured, but it can be controlled with proper medical care. Common strategies for management of asthma also include:

  • Bronchodilators to relax the muscles in your airways (inhalers)
  • Anti-inflammatory medications to reduce swelling and mucus production
  • Biologic therapies (a kind of medication made using microorganisms, plant cells, or animal cells) for severe asthma that has not been properly treated by other medications

If you smoke and have asthma and/or COPD, your doctor will encourage smoking cessation programs. These programs are created to help you quit smoking, which is a major cause of respiratory problems.

Differences Between COPD and Asthma

There are many similarities between COPD and asthma, and it’s important to understand the differences. These two lung conditions often are caused by different factors, affect different populations, and have different emergency signs and symptoms to look out for.

People with COPD have an ongoing, unchangeable blockage in the airways that worsens gradually and doesn’t get better over time. Asthma, however, shows a reversible pattern, meaning the blockages in the airways can be corrected with treatment. Asthma doesn’t show a consistent, permanent blockage. So, spirometry helps doctors figure out whether the lung problem is ongoing and progressing (COPD) or something that can be treated (asthma).

Major Causes

The main cause of COPD, which includes both chronic bronchitis and emphysema, is smoking. Tobacco smoke irritates the airways in the lungs, leading to inflammation that makes it harder for your lungs to absorb air. Smoke also reduces your lungs’ ability to remove particles from the airways. COPD is usually chronic (ongoing) and progressive, meaning your risk increases the longer that your lungs are exposed to smoke. In addition to smoking, you're more likely to develop COPD if you:

  • Are female
  • Are over the age of 65
  • Have been exposed to dust, air pollution, or fumes
  • Have alpha-1 antitrypsin deficiency (the body doesn’t produce enough of this protein, which helps protect the lungs and liver from damage)
  • Have a history of many lung infections as a child

Asthma is a disease that narrows and inflames your airways, making it harder for your body to take in enough oxygen. It can be caused by two main factors. The first is allergic asthma, associated with allergies to common irritants such as molds, mites, pollens, secondhand smoke, and pet dander. The second is nonallergic asthma, caused by exercise, stress, and illness. Just like COPD, asthma is more likely to affect people who are female and who are exposed to tobacco smoke.

Who Is Affected

COPD risk varies greatly from person to person. Someone with COPD may have few or all of the above risk factors. It is estimated that 15 million Americans were living with COPD in the United States in 2020, but many more have yet to be diagnosed.

Asthma is more common than COPD in the United States. More than 25 million Americans are currently living with asthma, including 5 million children. Childhood asthma begins before the age of 5, and children may outgrow it over time. Asthma can also begin in adulthood after the age of 18.

Flares

Both COPD and asthma can flare up and symptoms can worsen. While COPD and asthma exacerbations (flares or periods of worsening symptoms) have different symptoms, both can be scary experiences.

Signs of an asthma attack, which requires immediate medical attention, include:

  • Wheezing and coughing that has become worse than usual
  • Fast heart rate and breathing
  • Changes in mental status, such as exhaustion and confusion, which may lead to fainting
  • Blue lips or fingers, a sign that your body does not have enough oxygen

Signs of a COPD flare may include:

  • Worsening shortness of breath
  • Increase in cough or change in the amount and appearance of phlegm
  • Fever
  • Increasing swelling in your ankles, feet, and legs
  • Worsening fatigue or weakness

If you’re experiencing these symptoms, speak to your health care provider right away.

Asthma-COPD Overlap Syndrome

Sometimes, people with COPD are also living with asthma, making it difficult to tell which symptoms are caused by which condition. About one-third of people living with COPD are also living with asthma. The combination of these two conditions, called asthma-COPD overlap syndrome (ACOS), can lead to severe and complicated symptoms that require careful management by your pulmonologist.

One MyCOPDTeam member asked, “Does anyone with COPD have a chronic horrendous cough, or is that related to my asthma?” Another shared, “I have asthma as well as COPD, and I found out that smells cause a lot of problems with shortness of breath.” Managing both conditions can be tough and requires ongoing medical care. If you’re worried about having asthma and COPD, don’t hesitate to consult your doctor for advice and support.

Find Your Team

On MyCOPDTeam, the social network for people with COPD and their loved ones, more than 119,000 members come together to ask questions, give advice, and share their stories with others who understand life with COPD.

Are you living with both asthma and COPD? What tips do you have for others with the same conditions? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on August 30, 2023
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    Angelica Balingit, M.D. is a specialist in internal medicine, board certified since 1996. Learn more about her here.
    Scarlett Bergam, M.P.H. is a medical student at George Washington University and a former Fulbright research scholar in Durban, South Africa. Learn more about her here.

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