Asthma vs COPD: Know the Difference
Asthma and COPD (chronic obstructive pulmonary disease) are both lung diseases that make it hard to breathe. They both block the flow of air. And they both can cause shortness of breath, coughing, wheezing, tightness in your chest, and make you tired when you exercise.
But they are different conditions that need to be treated differently. Asthma is usually a reaction to an allergen or other trigger (like exercise). It causes airways to swell and become narrow. It also causes your body to produce more mucus. The combination of airway narrowing and mucus production leads to the breathing problems. Asthma symptoms can range from mild to life-threatening.
COPD is the name for several conditions that are caused by long-term damage to the lungs—the most common ones are emphysema and chronic bronchitis. The damage is caused by long-term exposure to irritants, like cigarette smoking. The airways are chronically inflamed, damaged, and blocked, causing coughing, difficulty breathing, and mucus production.
Asthma vs COPD
Not all inhalers are the same. It is very important to understand the specific instructions for each of your inhalers. Talk with your doctor to learn more. —Dr. Bina Choi
- People having an asthma flare typically have increased difficulty breathing, wheezing, and chest tightness, whereas those with COPD have increased difficulty breathing, but also increased phlegm production and cough.
- Both cause shortness of breath.
- Asthma can affect children, teenagers, and young and older adults. COPD usually occurs later in life.
- In asthma, the lungs are very reactive (hyperresponsive) to a specific trigger such as allergies, cold air, or exercise. COPD is more constant and not typically triggered by allergies. (COPD symptoms can get worse if exposed to a trigger, like smoking.)
- Because they are caused by triggers, asthma symptoms are reversible and sometimes preventable by avoiding triggers. Long-term poorly controlled asthma can lead to permanent damage. The damage to lungs that causes COPD is not usually reversible.
- If you have asthma, you may also have nasal polyps (a growth in the nose or sinuses), frequent sinus infections, seasonal allergies, and atopic dermatitis.
COPD vs asthma
- COPD usually comes on later in life. It is caused by decades of smoking cigarettes or exposure to other pollutants. Or it can be caused by an inherited genetic condition called alpha-1-antitrypsin deficiency. Asthma can affect children, teenagers, and adults and is not the result of long-term exposures.
- COPD causes a constant cough and lots of mucus. Asthma tends to only cause symptoms during an asthma attack (flare).
- The airways of the lungs are constantly inflamed, obstructed (blocked), and destroyed in COPD. Airways in people with asthma get more inflamed during a flare.
- COPD worsens over time.
Treating asthma and COPD
Recently, there have been developments of anti-inflammatory asthma medications called “biologics” that target specific immune cells in the body. These medications are injections that may be able to control asthma symptoms for an extended period of time. Examples include benralizumab, dupilumab, mepolizumab, omalizumab. However, they are only used for specific causes of asthma that are less common. Talk to your doctor to see if you qualify. —Dr. Choi
How to treat asthma
Treating asthma requires a comprehensive asthma management plan. You should discuss it with your doctor. You can find out more about keeping asthma under control at the American Lung Association. The main goals of treatment are to:
- Stop asthma flares when they come on. Short-acting inhalers such as albuterol/salbutamol (examples include ProAir, Ventolin, Proventil), are the main way to treat a flare. Inhalers are used to breathe medications directly into your lungs to open up airways. You may also take a short-acting inhaler (a pump) or nebulizer (aerosolized medicine given through a mask) during a flare, or you may be prescribed steroids to decrease inflammation during a flare.
- Reduce the number of flares. It’s important to avoid triggers when possible. If you know you will be exposed to a trigger, use your short-acting inhaler before the exposure. Depending on the severity of your asthma, your doctor may prescribe a long-acting inhaler medication to take daily, even if you don’t have symptoms every day. These typically include a combination of medications to reduce inflammation in your airways and reduce the number of flares.
- Reduce the severity and long-term effects of flares, such as loss of lung function and increased hospitalizations.
How to treat COPD
If you are diagnosed with COPD, the goals of treatment and approaches include:
- Slow down decline in function: Use inhalers and quit smoking.
- Improve functional status (the ability to walk and do normal life activities without feeling short of breath or needing to cut activities short): Use inhalers, quit smoking, do pulmonary rehabilitation, and use oxygen if needed.
- Increase length of life: Quit smoking and use oxygen if needed.
- Reduce exacerbations: Use inhalers, quit smoking, do pulmonary rehabilitation, and use oxygen if needed.
Is asthma or COPD worse?
Asthma and COPD are both dangerous in their own way.
A severe asthma attack can cause your airways to narrow so much that you are no longer able to breathe on your own. This happens when your short-acting inhaler is not effective enough. You’ll need immediate treatment at the hospital. Without prompt treatment, a severe asthma attack can cause death.
COPD has more long-term consequences and is always progressive and is the leading cause of death in the U.S. But you can reduce exacerbations with treatment. Even though you can't reverse the damage, you can slow the effects of damage and reduce the risk of death by quitting smoking and using oxygen therapy (in patients that meet criteria).
Very rarely, you may need lung transplantation, but this is a long process and a huge commitment for you and your family, so it is important that you discuss it with a pulmonologist at an appropriate transplant center.
It’s important to know the early warning signs of COPD, so you can help slow the progression of the disease:
- Chronic cough
- Shortness of breath while doing everyday activities
- Frequent respiratory infections (colds and coughs)
- Producing a lot of mucus (also called phlegm or sputum)
If you’ve been diagnosed with COPD, see your doctor if you notice the following symptoms, as they may be signs that your disease is getting worse:
- More frequent exacerbations/flares
- Needing your short-acting inhalers more times in a day or week
- More frequent infections in the last year
- You find yourself able to walk shorter and shorter distances
- You find yourself more breathless
Having asthma and COPD
Some people can have both asthma and COPD. It’s called asthma-COPD overlap syndrome (ACOS). Symptoms of ACOS include chest tightness, coughing with a mixture of saliva and mucus, and wheezing. It’s important to discuss the right treatment plan for you with your doctor.
Ask your doctor: What steps should I take to be as functional as I can be while managing COPD or asthma? What triggers and exposures should I be careful about? —Dr. Choi
Daily life with asthma or COPD
Both asthma and COPD are manageable if diagnosed early and treated with the correct inhalers. You can greatly reduce your symptoms and long term complications by taking several steps:
- Monitor your symptoms and see your doctor if they get worse.
- Know your triggers and prepare for them by using an inhaler (or avoid them).
- Take daily medications if directed by your doctor.
- Quit smoking and avoid second-hand smoke.
- Get your appropriate vaccines, including the yearly flu shots. Viruses and infections can worsen symptoms.
Dr. Choi is a board-certified Internist and current Pulmonary and Critical Care fellow at Brigham and Women’s Hospital. She completed her residency at Columbia University NewYork-Presbyterian Hospital, received her MD with a scholarly concentration in Health Services and Policy Research from Stanford School of Medicine, and received her BS from MIT. Her academic interests include clinical epidemiology, health policy, and medical writing.