COPD vs Asthma What’s the Difference

Chronic obstructive pulmonary disease (COPD) and asthma are lung diseases that affect millions of people worldwide. While both conditions cause shortness of breath, there are some differences when it comes to their symptoms, treatments, and what causes them.

Side-by-side comparison: COPD vs. asthma

Are COPD and asthma the same thing?

COPD and asthma do have some things in common. But they’re not the same thing.

COPD is a long-term lung condition that makes it hard to breathe. COPD can damage the airways traveling into your lungs as well as the tiny, round air sacs in your lung tissue. COPD is actually not a single disease but rather a term used for chronic lung diseases such as emphysema and chronic bronchitis. 

Most people who have COPD are older adults who have smoked for a long time. Exposure to air pollution or chemical fumes and dust can also cause COPD.

Similar to COPD, asthma is a chronic lung condition that makes it hard to breathe. Asthma causes inflammation in the airways of your lungs. The airways of people who have asthma are often sensitive to particles in the air that cause irritation or allergic reactions. People of all ages can have asthma, but it is particularly common in children and younger adults.

How common are they?

According to the Global Burden of Disease Study 2015, an estimated 174.5 million people worldwide had COPD and 3.2 million died from it in 2015. 

Compared to COPD, asthma is more common. The same study reported that an estimated 358.2 million people had asthma in 2015, which amounted to far fewer deaths, at 397,000.

What are the differences between COPD and asthma?

Because the symptoms of asthma and COPD are very similar, it can be hard to tell them apart.  But there are some things that distinguish them. 

Age 

Asthma often (but not always) begins in childhood. Some people with childhood asthma outgrow it, while others continue to have the condition as an adult. COPD is a disease that nearly always develops later in life, usually when someone is over age 40.

Causes 

Many people who develop asthma have a genetic predisposition to inflammation in their airways. And asthma attacks are triggered by exposure to things in the environment. COPD is normally caused by damage to the lungs that has occured over a long period of time, often from smoking or exposure to chemical fumes.

Symptoms

While both asthma and COPD can cause breathing problems, the symptoms are slightly different for each. In general, people with asthma have more variability in their symptoms. This means that they may have periods with no symptoms, but they can quickly develop shortness of breath or wheezing when exposed to a trigger. People suffering from asthma also tend to have a dry cough and do not bring up mucus. A person with COPD tends to have more persistent symptoms. They may have fluctuations in how severe the symptoms are, but the changes are less abrupt than in someone with asthma. People with COPD are also more likely to have a productive cough.

COPD

Cigarette smoking is the primary cause of COPD. Smoking cigars and pipes, as well as being exposed to second-hand smoke, also raises your risk of COPD. 

Other risk factors for the disease include exposure to:

• Indoor air pollution from burning wood, coal, or animal manure for cooking and heating 
• Outdoor air pollution
• Chemical fumes and dust 

A rare genetic disorder called alpha-1-antitrypsin deficiency can also make your lungs susceptible to damage and result in COPD.

Asthma

Asthma is caused by a combination of genes, factors in infancy and early childhood, and often an underlying problem with the immune system. This immune overreaction to substances in the environment is what triggers the airways to tighten and swell and causes the symptoms of asthma.  

Asthma, along with eczema and other allergic conditions, tends to run in families, which is how we know that genetics are involved. 

Being exposed to cigarette smoke while in the womb or in early childhood raises your risk for asthma. Researchers also think that whether or not you are exposed to certain bacteria and viruses in early childhood may also affect whether or not you develop asthma.

If you have asthma, then breathing in pollen, dust, chemical fumes, and air pollution can make your symptoms worse.

COPD

In the early stages of COPD, you may have no symptoms at all. Eventually, however, people with COPD tend to develop the following symptoms:

• Trouble breathing when moving around and, eventually, become short of breath when doing very little
• Ongoing cough that produces sputum
• Wheezing or making a whistling sound while breathing
• Chest tightness

People with COPD can also suffer from exacerbations, which is a sudden worsening of symptoms over a few hours or days.

Asthma

Asthma symptoms are usually worse at night or in the early morning. Symptoms are usually brought on by a trigger and include:

• Sudden trouble breathing 
• Chest tightness
• Wheezing
• Dry cough

Most people with mild or moderate asthma don’t have symptoms every day. (This is the main difference between asthma and COPD.) The symptoms will usually come on suddenly and can be triggered by things like:

• Pollen, dust, mold, pets, and cockroaches
• Viral respiratory infections (flu and the common cold)
• Air pollution
• Tobacco smoke
• Exercise
• Cold air

Asthma exacerbations, also called asthma attacks, are when symptoms suddenly flare up and are much worse than usual.

Diagnosing COPD or asthma starts with a comprehensive evaluation of your history. A provider will take into account factors such as:

• Your symptoms and what triggers them
• Whether you smoke
• Your other health conditions
• The health of your family members
• Your exposure to substances at home or the workplace

Your provider will also perform a physical exam, which includes:

• Checking your vital signs, including your oxygen level
• Listening to your lungs with a stethoscope to detect wheezing or other signs of lung disease
• Looking for physical signs of other potential causes of symptoms

However, a medical history and physical exam are often not enough to diagnose someone with COPD or asthma. Your provider will probably want to do a few more tests before they make a diagnosis.

How do you know if you have COPD or asthma?

The most useful test to figure out if you have asthma or COPD is called spirometry. This test measures how much air you can breathe in and out of your lungs and how fast you can do it. You may be asked to do the test before and after taking an inhaled medication (bronchodilator) to see how your lungs respond. Your results are then compared to normal ranges based on your age, height, and sex.

Chest X-rays and CT scans are also common tests for people who have trouble breathing. But, while these tests can show signs of pneumonia and other lung problems, they can’t determine for certain whether you have COPD or asthma.

How are these conditions treated?

COPD

There’s no cure for COPD. If you have the disease, there are two things you can do that can help you live longer:

• Quit smoking or don’t start smoking.
• If your oxygen level is already low when you’re in a resting state, use long-term supplemental oxygen with a portable tank.

Doing a pulmonary rehabilitation program helps a great deal with symptoms and confidence when you have COPD. It involves a structured regimen of exercise, education, and peer support.

Medications for COPD can help you feel better and reduce how often you have exacerbations. Which medications you take will depend on how serious your symptoms are and how often you have them. Common medications include:

• Inhaled bronchodilators: You inhale these medications into your lungs with a handheld device. The medication opens up your airways and makes it easier to breathe. Bronchodilators can be short-acting (4 to 6 hours) or long-acting (12 to 24 hours). Examples include albuterol (Ventolin, Proair, Proventil), formoterol (Perforomist), salmeterol (Serevent), ipratropium (Atrovent), and tiotropium (Spiriva).
• Inhaled bronchodilators plus inhaled steroids: If you have moderate to severe COPD, combining a bronchodilator and a steroid in the same inhaler is more effective at controlling symptoms than taking either separately. Examples of steroid-bronchodilator combinations for COPD include fluticasone/salmeterol (Advair) and budesonide/formoterol (Symbicort).
• Mucolytics: These are oral medications that loosen up the thick sputum inside your lungs, making it easier to cough it up. Examples of mucolytics for COPD are erdosteine, carbocysteine, and N-acetylcysteine.
• Antibiotics: If you have frequent COPD exacerbations, taking azithromycin (Zithromax) or erythromycin for one year can lower how many exacerbations you have.
• Corticosteroids: Medications like prednisone (Sterapred can help to improve inflammation and support healing in the lungs. These are often prescribed to treat a flare-up of COPD and can be slowly reduced over time to help recovery.

If you have a COPD exacerbation, treatment is more aggressive than what you do for day-to-day management and includes:

• Supplemental oxygen
• Inhaled or nebulized bronchodilators
• Oral or intravenous corticosteroids
• Oral or intravenous antibiotics
• Assistance with breathing from a ventilator mask and machine called BiPAP

Rarely, lung surgery may be recommended for severe cases of COPD. That could mean removing severely damaged parts of the lung or, in extreme cases, a lung transplant. 

Asthma

Childhood asthma sometimes goes away. But asthma that starts in adulthood usually does not.

Avoiding triggers is a good general strategy to limit your asthma symptoms. Although smoking may not be the primary cause of asthma in most people, smoking makes asthma symptoms worse. So people with asthma should quit smoking or not start.

A short-acting bronchodilator, like albuterol, is the only type of medication that can bring quick relief for acute asthma symptoms. Taken alone, these medications are best for people who don’t have daytime symptoms more than 2 days a week and don’t wake up at night more than twice a month due to asthma.

If you have more frequent symptoms, you may need to use maintenance medications every day to prevent or lower the frequency of acute attacks. Your choice of medication depends on how often you have symptoms during the week and how often you wake up at night due to asthma. Maintenance medications don’t work as quickly as short-acting bronchodilators, though, and you shouldn’t use them to relieve sudden asthma attacks. 

Maintenance medications for adults include:

• Long-acting inhaled bronchodilators
• Inhaled steroids
• Montelukast (Singulair), an oral medication that blocks leukotrienes, natural substances that can cause asthma symptoms
• Oral steroids, which are reserved for people with severe asthma because they can cause significant side effects when used long term

If you have acute asthma exacerbations, your treatment may involve:

• Bronchodilators given by a nebulizer machine, which turns liquid medication into a fine mist that is easy to inhale deep inside the lungs
• Oral or intravenous corticosteroids
• Oral or intravenous antibiotics
• Assistance with breathing from a ventilator machine if you are really sick 

What is asthma-COPD overlap syndrome (ACOS)? 

Some people have symptoms of both COPD and asthma. This is called asthma-COPD overlap syndrome. 

People with the overlap syndrome tend to be younger than people with COPD and older than those with asthma. Diagnosing this condition can be hard, particularly if a person falls in an age group in which both COPD and asthma are common. But one indication is that the symptoms tend to be more frequent than with COPD or asthma alone. They also tend to be more severe, leading to more emergency room or hospital visits. 

Asthma-COPD overlap syndrome can be managed with the same strategies and medications as COPD and asthma.