Asthma vs. COPD: How can you tell the difference?

Have you found that you’re short of breath more often than normal? Maybe when doing simple things such climbing the stairs or walking from your car to the supermarket?

You might have one of 2 common lung conditions: asthma or chronic obstructive pulmonary disease (COPD). They’re both conditions that affect how well your lungs function (more on each below).

Specifically, you might be asking yourself, “What causes asthma and COPD? And what are the symptoms I should know about?”

While asthma and COPD have a lot in common, there are some important differences, says Neil Schachter, M.D. He’s a lung specialist at the Mount Sinai Medical Center in New York City. Here’s what to know.

Get coverage for the care you need with the right health insurance plan. Call a licensed insurance agent at (800) 827-9990, or compare plans online today.

What are asthma and COPD, exactly?

Both asthma and COPD are chronic conditions that cause inflammation of the lungs.

Asthma is slightly more common than COPD. Nearly 8% of Americans have asthma, according to the Centers for Disease Control and Prevention (CDC). You can develop it at any age, but it most often starts in childhood.

One telltale sign of asthma is that it’s often triggered by allergens such as pollen or dust mites, says Dr. Schacter. Additional triggers include:

• Cold air
• Emotional stress
• Exercise
• Mold
• Pet dander (dead skin cells)
• Viral infections

As a result, people with asthma may notice that their breathing is more difficult during certain activities or at certain times of year.

COPD, on the other hand, is a broad term for a group of conditions that damage your airways. It affects roughly 6% of Americans, according to the CDC.

The 2 main types of COPD are:

• Emphysema, where there’s damage to the walls between the air sacs in your lungs
• Chronic bronchitis, where there’s constant airway irritation and inflammation

Unlike asthma, which often comes on quickly due to triggers, COPD symptoms start mild and progress over time.

“The typical COPD patient is someone over the age of 50 who begins to experience shortness of breath that worsens slowly,” explains Dr. Schachter. “Asthmatics, on the other hand, have symptoms that get dramatically worse frequently and are usually related to triggers like allergies. Their symptoms frequently (but not always) begin at an early age.”

What are the symptoms of asthma and COPD?

The symptoms of asthma and COPD are very easy to confuse. Both asthma and COPD cause shortness of breath, coughing, chest tightening and wheezing. But there are a few specific signs to look for:

• A daily morning cough that produces phlegm is more common with COPD. This is likely to indicate chronic bronchitis.
• Wheezing and chest tightness that worsen at night are more common with asthma.
• People with allergies such as hay fever or eczema (a skin rash) are more likely to have asthma.

If your doctor thinks you have asthma or COPD, they’ll likely give you a lung-function test known as spirometry. This measures how much air your lungs can physically breathe out after a deep breath and how fast that air can be exhaled. This test is repeated several times in order to select your best effort.

After the first test, you maybe be given a bronchodilator, which is an inhaled medication that relaxes the muscles in your airways. Then you’ll test again. “People with COPD tend to be less responsive to the bronchodilator than people who have asthma,” says Dr. Schachter. Other lung function testing may also be done to characterize your illness.

In addition to these tests, your doctor will also take a thorough medical history. This frequently involves questioning whether your symptoms worsen with specific triggers, whether there is a family history of lung disease, whether you smoke (or have smoked) cigarettes, and what occupational or environmental exposures you have had. All of this will help your doctor make a diagnosis.

In some cases, people have features of both conditions. “About a quarter of COPD patients also have features of asthma,” says Dr. Schachter. “This is sometimes referred to as asthma-COPD overlap syndrome. These tend to be people who have a history of both smoking and allergies.”

Having health insurance can help you pay for treatment for chronic conditions. Call a licensed insurance agent at (800) 827-9990, or compare plans online today.

How are asthma and COPD treated?

Doctors often use the same drugs to treat both conditions, but “the way they are applied is often very different,” says Dr. Schachter. The 2 main types of medication are:

• Bronchodilators. These relax the muscles around your airways, opening them up to make breathing easier. Short-acting bronchodilators last about 4 to 6 hours, and long-acting ones last for up to 24 hours.
  “Both groups of patients respond well to bronchodilators,” says Dr. Schachter. “But COPD patients tend to respond best to certain types, like long-acting muscarinic antagonists (LAMAs) or long-acting beta2-agonists (LABAs) or a combination of both. Short-acting bronchodilators are often used as rescue medications when symptoms suddenly increase.
• Steroids. These are medications that reduce airway inflammation. “For people with asthma, inhaled steroids are usually the bedrock of treatment, and then we add on a bronchodilator if their symptoms aren’t well controlled or get worse,” says Dr. Schachter. “On the other hand, we tend to reserve steroids for severe cases of COPD,” he adds — or for asthma-COPD overlap or in the case of COPD exacerbations, where they are usually given in pill or injected form.

There are also other treatments your doctor may recommend to help you treat your COPD. These include:

• Pulmonary rehabilitation. This is a supervised program where you’ll learn breathing techniques and exercises to help keep your lungs strong.
• Oxygen therapy. This is a treatment that delivers oxygen for you to breathe. You usually get it from tubes that rest in your nose, a face mask, or a tube placed in your trachea (windpipe).
• Surgery. Traditionally, this has been reserved for patients with very severe COPD, but it’s being used more frequently. It includes lung volume reduction surgery and lung transplantation, as well as valve surgery, where valves are placed in your airways to help you breathe better.
  More recently, airway valves have been used, which involves placing small valves in the airways with a bronchoscope to help improve your lung function so that you can breathe better. “Some people have localized, overexpanded areas in their lungs from COPD damage, and the one-way valves help to deflate these overinflated areas,” says Dr. Schachter.

How do you manage asthma and COPD?

If necessary, your doctor will work with you to pinpoint triggers and figure out a plan to avoid them. You’ll also receive the appropriate medication and counseling on lung health.

With both asthma and COPD, you may become more vulnerable to lung infections. So, you’ll want to stay up to date with yearly flu shots and COVID-19 boosters.

If you smoke, it’s critical that you quit. You’ll also want to avoid secondhand smoke. While smoking itself doesn’t cause asthma, it can make symptoms worse. And smoking does cause — and can intensify — symptoms of COPD. If you need help quitting, reach out to your doctor or visit smokefree.gov.

Get coverage for the care you may need with the right health insurance plan. Call a licensed insurance agent at (800) 827-9990, or compare plans online today.