Asthma vs COPD: what is the difference?
Asthma and chronic obstructive pulmonary disease (COPD) are the two most common long-term airway diseases. Both can cause cough, wheeze and breathlessness, so they are often confused. Getting the label right matters, because the treatment and the long-term outlook are different.
How the two conditions differ
- Age of onset: asthma often starts in childhood or young adulthood; COPD usually appears after the age of 40.
- Cause: asthma is linked to allergy and airway inflammation; COPD is linked to long-term smoking, biomass (chulha) smoke, dust and pollution.
- Pattern of symptoms: asthma symptoms come and go, are often worse at night and are triggered by dust, cold air or exercise; COPD breathlessness is more persistent and slowly progressive.
- Reversibility: airway narrowing in asthma largely reverses with treatment; in COPD it is only partly reversible.
- Phlegm: a daily productive cough is more typical of COPD.
How a pulmonologist tells them apart
The key test is spirometry with a reversibility test: breathing tests are done before and after a reliever inhaler. A large improvement points towards asthma, while persistent narrowing points towards COPD. A chest X-ray, and sometimes a CT scan or blood eosinophil count, adds further information. Some people have features of both conditions, which also needs a tailored plan.
Treatment is not the same
- Asthma is controlled mainly with daily inhaled steroid-containing preventer inhalers.
- COPD is treated mainly with long-acting bronchodilator inhalers, with inhaled steroids added only for selected patients.
- Stopping smoking, correct inhaler technique, vaccination and a flare-up action plan help both.
Do not change or stop inhalers on your own. If you are not sure which condition you have, ask for a spirometry test.
Frequently asked questions
Can asthma turn into COPD?
Long-standing, poorly controlled asthma can lead to some permanent airway narrowing, and smokers with asthma are at higher risk. Good asthma control and not smoking reduce this risk.
Which test confirms asthma or COPD?
Spirometry with a bronchodilator reversibility test is the standard test for both.
Medical disclaimer: This article is for general education and is not a substitute for a personal consultation. Do not start, stop or change any medication on the basis of this page. For advice specific to you, consult Dr. S.A. Rafi at City Chest Clinic, Mehdipatnam, Hyderabad.
20+ years of pulmonology practice in Hyderabad. Director of City Chest Clinic, Mehdipatnam and Chief Consultant Pulmonologist & Sleep Specialist at KIMS Hospitals, Gachibowli.
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