What are the Differences between Asthma and COPD?

Introduction
Characteristics of Asthma
Characteristics of COPD
Key Differential Factors between Asthma and COPD
Specific Treatment Plans for Asthma and COPD
References


Asthma and chronic obstructive pulmonary disease (COPD) are both health conditions involving the respiratory system and can lead to difficulty breathing. There is some overlap between the two conditions, and it is estimated that approximately 40% of patients with COPD also have asthma.

However, the two conditions have some distinct differences in their pathophysiology, presentation of symptoms, and optimal management plans. The key differences to aid in diagnosis and treatment decisions are outlined below for these two lung diseases.

Asthma and COPD Concept

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Characteristics of Asthma

Asthma is a chronic inflammatory disorder of the airways that leads to recurrent symptoms such as wheezing, breathlessness, chest tightness and coughing, commonly occurring at night or in the early morning.  These flare-up periods are associated with triggers that obstruct the airways, which are usually reversible.

Diagnosis of asthma most commonly occurs during childhood, in individuals with a history of dry cough at night, although it can present at any age.

Characteristics of COPD

COPD is a disease characterized by the progressive obstruction of the airways that leads to a reduction in airflow and respiratory function. These changes are not completely reversible, and inhaled noxious particles or gases, such as cigarette smoke, are associated risk factors for the condition. Long-term exposure to cigarette smoke whether through direct tobacco smoking or secondhand smoke can also be a risk factor. 

Diagnosis of COPD usually occurs in older adults with a smoking history or chronic exposure to other inhaled irritants.

Key Differential Factors between Asthma and COPD

Both asthma and COPD are chronic inflammatory diseases of the small airways involving mucus and bronchoconstriction that limit the airflow. However, the differences between the two conditions are important and affect how we manage them.

The reversibility of the damage to the airways is a significant difference between asthma and COPD. The airway obstruction in asthma is largely reversible in patients with asthma, whereas the obstruction in COPD is considered irreversible or less reversible.

The difference in reversibility is highlighted in lung function tests, such as spirometry results. Both show a reduction in airflow, but assessing the effect of bronchodilator administration can help to differentiate between the conditions. Asthma exhibits greater reversibility, and results tend to improve with the administration of bronchodilators, whereas COPD shows less improvement with bronchodilator medication.

The classification of severity of asthma and COPD also differs. The severity of asthma is based on the lung function and frequency and severity of symptoms; the severity of COPD is based primarily on the function of the lungs.

COPD

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Specific Treatment Plans for Asthma and COPD

As the pathology and cause of inflammation are distinct in asthma and COPD, the treatment plan will differ accordingly. While the aim of treatment in asthma is to suppress chronic inflammation, the main aim in COPD is to reduce symptoms.

There is significant evidence to support the use of anti-inflammatory drugs in asthma patients to improve symptoms. This is thought to affect the airways by slowing the remodeling that may occur in some patients.

The management of COPD is faced with greater challenges, and, at this point, no medications are available that modify the progression of the disease. Instead, managing certain risk factors is considered beneficial, such as stopping smoking. Inhaled corticosteroids may help decrease exacerbation frequency in patients with COPD and improve quality of life.

References:

  • Cirino, E. (2015). Asthma and COPD: How to Tell the Difference. [online] Healthline. Available at: https://www.healthline.com/health/copd/asthma.
  • Buist, A.S. (2003). Similarities and differences between asthma and chronic obstructive pulmonary disease: treatment and early outcomes. European Respiratory Journal, [online] 21(Supplement 39), pp.30S35S. doi:10.1183/09031936.03.00404903.
  • Murphy, A. (n.d.). Knowing the differences between COPD and asthma is vital to good practice. [online] The Pharmaceutical Journal. Available at: https://pharmaceutical-journal.com/article/ld/knowing-the-differences-between-copd-and-asthma-is-vital-to-good-practice.
  • Athanazio R. Airway disease: similarities and differences between asthma, COPD and bronchiectasis. Clinics (Sao Paulo). 2012 Nov;67(11):1335-43. doi: 10.6061/clinics/2012(11)19. PMID: 23184213; PMCID: PMC3488995.

Further Reading

Last Updated: Aug 10, 2022

Yolanda Smith

Written by

Yolanda Smith

Yolanda graduated with a Bachelor of Pharmacy at the University of South Australia and has experience working in both Australia and Italy. She is passionate about how medicine, diet and lifestyle affect our health and enjoys helping people understand this. In her spare time she loves to explore the world and learn about new cultures and languages.

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