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Is It Asthma or COPD? Know the Difference

By Gary Fitzgerald – Allery & Asthma Network

People with chronic cough, wheeze and shortness of breath may wonder if their symptoms are asthma or chronic obstructive pulmonary disease (COPD). The difference between the two diseases is not always clear.

May is Asthma Awareness Month, and Allergy & Asthma Network joins with the US COPD Coalition in raising awareness of these life-threatening lung diseases. More than 24 million people live with asthma, while approximately 16 million are diagnosed with COPD, according to the U.S. Centers for Disease Control and Prevention (CDC). Woman are more than two times as likely to get COPD as men.

Apart from prevalence data, what are the differences between the two diseases?

Asthma is usually diagnosed early in life. Symptoms include:

• Coughing
• Wheezing
• chest tightness
• Shortness of breath

Asthma flares are often triggered by allergies (pollen, mold, pet dander, dust mites) and irritants (air pollution, chemicals in cleaning products). Respiratory infections like the cold or flu are also common triggers.

Asthma results in approximately 3,600 deaths per year, or 1 in 10 people with the disease.

COPD tends to occur in people after the age of 40. The two diseases that make up COPD are emphysema and chronic bronchitis. Symptoms are the same as asthma but may also involve:

• Increased mucus or phlegm with cough
• Frequent colds
• Nasal and throat infections
• Fatigue
• Blue lips or fingernails – a symptom you may not have enough oxygen in your blood

COPD is considered more serious than asthma and tends to get worse over time. Approximately 120,000 people die of COPD each year, making it the third leading cause of death in the United States, according to CDC. It can lead to permanent lung damage.

Many people develop COPD after years of exposure to something that irritates the lungs. For most, it’s cigarette smoking. For others, it could be long-term exposure to air pollution or fumes in the workplace.

Can asthma lead to COPD? Not necessarily. A person whose lungs are damaged due to poorly controlled asthma and exposure to irritants such as tobacco smoke is at increased risk of COPD.

Given the similarity of symptoms between the two diseases, it’s perhaps not surprising the COPD is sometimes misdiagnosed as asthma. It’s also possible for people to have both diseases at the same time – this is called Asthma-COPD Overlap, or ACO. People with ACO tend to have frequent exacerbations and a more rapid decline in lung function.

Treatments for these conditions are similar – but with one notable difference.

Asthma, COPD and ACO patients are prescribed quick-relief albuterol inhalers to treat symptoms that arise suddenly. Each group uses inhaled corticosteroids (ICS), long-acting beta-agonists (LABA), long-acting muscarinic antagonists (LAMA), or a combination medication of the three to control airway inflammation daily.

In recent years, biologics have emerged as a revolutionary treatment for asthma. These medications target specific cells and pathways that cause airway inflammation, stopping symptoms before they can start.

Biologics are not available for COPD, although recent research shows promise in finding a precision biomarker that could target the disease. Doctors may recommend oxygen therapy for severe cases of asthma and COPD.

Pulmonary rehab has also been shown to benefit severe asthma and COPD patients as well. Pulmonary rehab is a whole-body approach to treatment that involves patient education, exercise, nutrition, and more. The program can shorten hospital stays and increase participation in daily activities.

Asthma and COPD can change over time, which means medication needs may change, too. Patients should work closely with their doctor to evaluate which medications work best at any given point in time.

Lifestyle changes to avoid triggers are also key to successfully managing both conditions. For starters, it’s critical that asthma and COPD patients not smoke. It’s the single most important thing to do to slow the rate of lung function decline, regardless of disease severity. If stopping is too hard, talk with a doctor about smoking cessation programs.

It’s also important to get annual pneumonia and flu vaccinations to ward off viruses. CDC recommends both vaccines for asthma and COPD patients.

The COVID-19 pandemic provided both good and bad news for people with asthma and COPD.

First, the good news: asthma and COPD patients are not at an increased risk for contracting COVID-19. And now the bad news: patients with moderate-to-severe asthma and COPD patients are at risk for severe COVID-19 if they do contract the virus.

A recent study revealed that 83% of people with COPD say that COVID-19 has served as a wake-up call to realize their disease puts them at risk. And 98% say they want to be as healthy as they can to fight off COVID-19.

Asthma and COPD patients can take steps to protect themselves. Practicing the three Ws – wear a mask, wash your hands, and watch your distance from other people. If you don’t feel you can wear a mask due to severe asthma and COPD, it may be best to stay home and avoid public places. Ask family and friends to run errands for you. If you must go out, avoid large crowds, and practice social distancing.

Allergy & Asthma Network has placed an urgent priority on addressing asthma, COPD and COVID-19 disparities. These conditions disproportionately affect Black, Hispanic/Latino and Native American communities, especially those in urban areas. They face higher rates of emergency department, hospitalization and deaths due to asthma, COPD and COVID-19.

Allergy & Asthma Network’s Not One More Life Trusted Messengers saw an opportunity to engage those impacted by health disparities by going where they gather: churches, faith-based settings and other community venues. Starting in September 2020, the Network has hosted more than 20 Not One More Life events.

Attendees received free asthma and COPD screenings and COVID-19 education and vaccinations. They were given referrals and patient education to make informed, evidence-based decisions about their health. Furthermore, uncontrolled high-risk patients were enrolled in a digital health/telehealth coaching program free of charge for six weeks. To date, over 5000 patients have been screened and more than 500 received coaching to improve lung function and quality of life.

Expanding access to care and encouraging underserved communities to participate in research are key in achieving health equity. Allergy & Asthma Network is excited to be a part of the US COPD Coalition as we work together to address the needless death and burden caused by asthma and COPD.