Asthma and chronic obstructive pulmonary disease (COPD) are both respiratory conditions that are chronic and affect a person’s breathing. With many shared similarities, the two can easily be misdiagnosed for one another and that is why testing is so important to determine the exact diagnosis.
According to a presentation given at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting, nearly 50 percent of older adults with an obstructive airway disease have overlapping characteristics of COPD and asthma.
Presenter and allergist William Busse said, “Based on symptoms alone, it can be difficult to diagnose COPD vs. asthma. The pathway to a diagnosis of COPD or asthma — smoking vs. a long-term persistence of asthma — can be quite different. In every patient, but in older patients in particular, we need to take a thorough history and perform a physical examination, as well as measurements of lung functions. In patients with COPD and asthma, the changes in lung function may be severe, and it is not often readily apparent, which is the predominant, underlying condition — asthma or COPD. Treatment will differ depending on diagnosis.”
ACAAI president Michael Foggs added, “The primary treatment in COPD is bronchodilators, including long-acting beta agonists. They help relax muscles around the airways in the lungs, allowing air to flow more freely. They should not be given alone to people with asthma. In COPD, but not asthma, inhaled corticosteroids have been associated with an increased risk for pneumonia, and in some cases, features of both asthma and COPD exist. For these patients, a combination of inhaled corticosteroids and long-acting beta agonists is usually best.”
Aside from symptoms, treatment methods can also be similar in COPD and asthma. For example, bronchodilators are used in both COPD and asthma. Both patients are also advised to avoid triggers, especially smoke.
Below we will reveal more of the similarities and differences between COPD and asthma to help you understand what makes each disease unique.
The primary difference between COPD and asthma lies in their pathophysiology – the functional changes associated with either condition. Both result from inflammation and hyperactivity, but COPD results from macrophages and neutrophils, and develops over time – unlike asthma.
Asthmatic inflammation occurs over a short period of time and results from eosinophils.
In asthma, the airways become inflamed and irritable in response to an allergen, and in COPD the lungs get damaged by certain irritants.
Another key difference between the two is that in asthma airflow can be restored, but in COPD airflow is only temporarily restored or not restored at all.
The CDC reports that one in 14 Americans live with asthma, with a total of about 24 million Americans suffering the condition. Of these, 7.4 percent are adults and 8.6 percent are children. As you can see, asthma is more common in children than adults, and boys develop asthma more often than girls.
Every day, an estimated 10 Americans die of asthma, and many of these deaths are avoidable and preventable. Since 1999, asthma-related deaths have increased by 26 percent. African Americans are at a higher risk of death by asthma than other ethnic groups.
Asthma costs roughly $3,300 per patient annually including medical costs, time missed from work, and early death. Costs for asthma in the U.S. have risen from $53 billion in 2002 to $56 billion in 2006.
The World Health Organization (WHO) estimates the 65 million people worldwide are affected by COPD, and over three million have died from the respiratory disease.
Direct healthcare expenditures for COPD in 2010 in the U.S. amounted to $29.5 billion. Indirect mortality costs were $12.4 billion and indirect morbidity costs were $8 billion.
Below is a chart for easy reference outlining the differences and similarities between COPD and asthma.
|Introduction||Asthma is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm.||Chronic obstructive pulmonary disease (COPD) is a type of obstructive lung disease characterized by chronically poor airflow.|
|Symptoms||Chronic coughing, wheezing, shortness of breath, chest tightness, spasms in bronchioles. Symptoms go away between episodes.||Decreased airflow, increased inflammation, spasms in bronchioles, morning cough with phlegm. Symptoms never disappear, but progressively worsen.|
|Nature of cough||Dry||“Productive” (yields mucus)|
|Diagnosis||Physical exam, medical history, including history of allergies
Typically in children
|Spirometry measuring lung function and capacity, CT scans
Typically in adults over 40
Current or former smokers
|Classical Presentation||Younger patient, recurrent episodes of wheezing and coughing, accompanying tight chest and breathlessness.
Symptoms quickly respond to bronchodilators.
|Older patient, smoker or former smoker, progressive shortness of breath and cough with mucus, accompanied by decreased physical activity.
Responds to bronchodilator, but lung function does not return.
|Triggers||Allergens, cold air, exercise||Environmental pollutants, respiratory tract infections – pneumonia, influenza|
|Risk Factors||Allergies, eczema, rhinitis||Asthma, smoking|
Airway opening medication
Inhaled corticosteroids to reduce inflammation
Oral steroids for moderate to severe cases
Airway opening medication
Oxygen support for advanced stages
|Lifestyle Changes||Cease smoking, avoid allergens and air pollution||Cease smoking, avoid air pollution|
Factors that increase a person’s risk of developing asthma include having a blood relative with asthma, having another allergic condition, being overweight, being a smoker, and being exposed to second-hand smoke, exhaust fumes, or pollution, as well as occupational triggers such as hairspray or chemicals used in farming.
If asthma is not well managed, the risk of complications rises. Complications related to unmanaged asthma include sleep interference, days off from work and school, permanent narrowing of bronchial tubes that affects breathing, emergency room visits, and side effects associated with medications.
Risk factors of COPD include being exposed to tobacco smoke, especially being a long-time smoker, having asthma already and smoking, being exposed to occupational triggers such as dust and chemicals, being 35 to 40 years of age, and having an uncommon genetic disorder – alpha-1-antitrypsin deficiency.
Symptoms of asthma include shortness of breath, chest tightness or pain, trouble sleeping due to breathing difficulties, whistling or wheezing sound when exhaling, and coughing.
Symptoms of COPD are very similar to asthma, but also have some differences including shortness of breath, wheezing, chest tightness, the urge to clear mucus from your throat in the morning, chronic cough, blueness of lips or fingernail beds, frequent respiratory infections, lack of energy, and unintended weight loss, which is more common in the later stages of the disease.
The cause of asthma is unclear, but it could be a combination of genetic and environmental factors. Some common triggers of asthma include airborne allergens, respiratory infections, physical activity, cold air, air pollutants, certain medications, strong emotions and stress, sulfites and preservatives, and GERD.
In developed countries, smoke is the primary cause of COPD, but other causes include emphysema and chronic bronchitis. Lung damage, either due to cigarette smoking or other irritants, can contribute to the onset of COPD, too.
In some patients, COPD is a result of a rare genetic disorder that causes low levels of alpha-1 antitrypsin (AAt), which is a protein made by the liver that protects the lungs.
Asthma diagnostic tests include spirometry, which estimates the narrowing of your bronchial tubes, and peak flow, which measures how hard you breathe out. Additional tests include methacholine challenge, nitric oxide test, imaging tests, allergy testing, sputum eosinophils, and provocative testing for exercise and cold-induced asthma.
Treatment for asthma is lifelong and often involves inhaled medications including inhaled corticosteroids. Other medications used to treat asthma include leukotriene modifiers, long-acting beta agonists, combination inhalers, and quick-relief medications for rapid, short-term relief of asthma symptoms.
Working closely with your doctor can help you develop an asthma control plan, which includes your triggers and medication dosages. Regular check-ups with your doctor can also see the progress of your asthma and make any required changes to your asthma control plan.
Common treatments for COPD include smoking cessation, medications like inhaled steroids, bronchodilators, combination inhalers, oral steroids, antibiotics, lung therapies, and surgery including lung column reduction surgery where damaged parts of the lungs are removed to create more space for healthy lung tissue to expand, and a lung transplant.
Lifestyle and home remedies can also aid in treatment for COPD. Some lifestyle adjustments include controlling your breathing, clearing your airways by drinking plenty of fluids and using a humidifier, exercising regularly, eating healthy foods, avoiding smoke and air pollution, and having regular checkups with your doctor.