What’s the Difference Between Asthma and COPD?

Asthma and COPD are both chronic (long-term) respiratory conditions, but their causes, progression, and treatment approaches differ.

Starting Age

One of the biggest differences between asthma and COPD is the average age at which the two conditions begin.

Asthma often begins in childhood, with about 80% of people with asthma first developing symptoms before age 6, though it can start at any age. An overactive immune response to triggers is the leading cause of airway swelling from asthma.

Asthma also often runs in families. This is known as the atopic march, where people with a family history of allergies develop related conditions over time. The atopic march often starts with atopic dermatitis (eczema) in babies, turning into allergic rhinitis (hay fever) in childhood, which may eventually lead to asthma.

Environmental triggers, such as early exposure to indoor allergens like house dust mites or certain molds, can raise your risk of asthma. 

COPD typically develops in adults over 40, usually due to long-term exposure to harmful irritants that damage your airways and lungs. Smoking is the leading cause of COPD, but air pollution and occupational exposure to irritants like chemical fumes can also contribute.

COPD involves gradual damage to your alveoli (air sacs in your lungs) and your airways, causing a loss of elasticity (stretchiness) along with thickening and inflammation of your airway walls. This damage makes it harder for air to move in and out of your lungs, contributing to progressive breathing difficulty.

Disease Progression 

Although asthma and COPD are both chronic respiratory diseases, how they progress differs.

Asthma: It is often episodic, with symptoms flaring up in response to specific triggers and then disappearing, especially when using medications to control airway swelling. If left untreated, long-term airway swelling can permanently damage your lungs. However, lung damage is preventable with proper management of asthma. 

COPD: It is a gradual condition that causes irreversible damage, including emphysema (destroying the alveoli walls) and/or chronic bronchitis (airway swelling from mucus overproduction). These changes progressively worsen, leading to declining airway and lung function. As COPD worsens, people may experience increasing difficulty breathing, chronic cough, and frequent respiratory infections. 

While asthma can sometimes resolve or improve with age, COPD is a progressive disease that worsens over time.

Treatment Goals

The treatment goals for asthma and COPD have some differences.

Asthma: Asthma treatment primarily focuses on preventing asthma attacks by relieving airway swelling and managing symptoms. Bronchodilators (rescue inhalers) provide quick symptom relief. Maintenance medications, such as inhaled corticosteroids or biologics, help control inflammation. With proper treatment, many people with asthma can maintain normal or near-normal lung function.

COPD: Treatment options are similar to those for asthma but are focused on managing symptoms, improving quality of life, and slowing the disease’s progression rather than curing the condition. While bronchodilators and anti-inflammatory medications can help improve airflow and reduce symptoms, they can’t reverse the structural damage to the lungs and airways.

Asthma and COPD share similarities in how and why symptoms flare up, as well as in treatment approaches.

Flare-Up Patterns

Asthma and COPD both have periodic (repeated) flare-ups. A flare-up is when symptoms suddenly worsen.

Flare-ups can happen in asthma and COPD from specific triggers, such as:

• Respiratory infections, like the common cold
• Strong odors or irritants, such as air pollution or cigarette smoke 
• Allergens, like pollen or pet dander 
• Sudden weather changes, extreme temperatures, or humidity

What triggers a symptom flare-up can vary from person to person. During these episodes, inflammation worsens, and a person with COPD or asthma might experience more intense symptoms.

These symptoms may include:

• Severe shortness of breath or difficulty breathing 
• More frequent or severe coughing 
• Difficulty sleeping 
• Increased wheezing or noisy breathing
• Fatigue
• Chest tightness or pain 

Flare-ups can be life-threatening and require prompt treatment. In COPD and asthma, frequent flare-ups can lead to airway and lung damage and worsened lung function.

Airway Changes

Asthma and COPD can lead to structural changes in your airways over time. Known as airway remodeling, this happens when inflammation in your lungs and airways causes your body to try to repair itself, similar to how skin may form a scar after healing from a cut. 

In asthma, chronic inflammation and repeated flare-ups can lead to thickening of the airway walls, excess mucus, and loss of airway elasticity. In COPD, ongoing swelling and continued irritation, such as from smoking, cause permanent damage to your lungs and airways.

Over time, airway remodeling can worsen symptoms for people with either condition. Following your treatment plan can help prevent further damage.

Treatment Options 

Asthma and COPD share similar treatment options to control and manage symptoms and improve quality of life. Healthcare providers commonly prescribe bronchodilators, medications that relax and open your airways, for both conditions. They also prescribe inhaled corticosteroids, which reduce inflammation. 

People with asthma or COPD can also benefit from pulmonary rehabilitation, a medically supervised program that helps people with respiratory diseases breathe better. Pulmonary rehabilitation programs include exercise training, breathing techniques, and education to improve strength and make it easier to handle everyday tasks, work, and activities like social events when living with asthma or COPD. 

It is possible to have both asthma and COPD, a condition known as asthma-COPD overlap syndrome (ACOS). This occurs when a person experiences symptoms and characteristics of both conditions, such as airway inflammation from asthma and progressive airflow limitation and damage from COPD.

ACOS is not a separate condition but a way for healthcare providers to identify if a person has a combination of symptoms from both conditions and recommend the most appropriate treatment plan. 

People with the highest risk of ACOS include people with asthma who smoke and people with COPD who have underlying allergies, such as allergic rhinitis. While asthma itself doesn’t directly cause COPD, long-term, untreated asthma can potentially raise the risk of having COPD over time. 

Telling the difference between asthma and COPD can be hard due to overlapping symptoms, including shortness of breath, coughing, and wheezing. Healthcare providers can determine whether you have both by taking a detailed medical history, focusing on the age at which your symptoms started, smoking history, and family history.

Your provider may also order pulmonary function tests, spirometry, and imaging scans to provide an accurate diagnosis. Pulmonary function tests check to see how well your lungs are functioning. Spirometry checks how fast a person can inhale and exhale. 

If you’re experiencing symptoms like shortness of breath, wheezing, chronic coughing, or increased difficulty breathing but are not diagnosed with asthma or COPD, contact a healthcare provider. They may refer you to a pulmonologist, a doctor specializing in diagnosing and treating respiratory conditions.

It’s important that people with an asthma or COPD diagnosis talk to their healthcare provider if symptoms worsen, flare-ups become more frequent, or their current medications aren’t controlling symptoms. They may need to adjust medications or try new treatment options.

If you experience sudden worsening symptoms or notice signs of infection, such as fever or increased mucus production, seeking prompt medical attention is important.

Asthma and COPD are both chronic respiratory conditions that affect breathing but differ in their causes, starting age, and progression.

It’s possible to experience both conditions, known as ACOS. This requires a tailored treatment plan.

Early diagnosis and treatment of asthma and COPD can help improve lung function and quality of life and prevent complications.