Coughing, wheezing, and other respiratory symptoms can be frightening, especially when they happen frequently.
Both asthma and chronic obstructive pulmonary disease (COPD) can cause serious respiratory symptoms. Knowing the difference between the two is key to effective treatment.
To make a diagnosis, doctors will evaluate a person's symptoms, their medical history, and do a physical exam. People who have breathing problems can get a faster, more accurate diagnosis by providing clear details about their symptoms, lifestyle, and medical issues.
People with asthma have swollen, sensitive airways. This inflammation makes the airways more reactive, causing the muscles to tighten and mucus production to increase. The swelling, mucus, and tightening make it difficult to breathe, causing an asthma attack but these changes are reversible and come and go.
Symptoms of an asthma attack can include:
- A feeling of heaviness in the chest or lungs
- Rattling in the chest
- Difficulty breathing
- Tightness in the neck or throat
- Difficulty walking or talking
Some people experience warning signs before an asthma attack, such as difficulty sleeping, coughing, anxiety, and changes in mood.
A range of triggers can cause an asthma attack, and triggers vary from person to person. Many people with asthma have allergies, so allergens are a common trigger.
Other triggers include:
- Illnesses, such as the common cold, the flu, and upper respiratory infections
- Physical exertion
- Strong smells, such as perfume or cleaning products
- Cold, dry air
- Weather changes
- Excessive laughing or crying
- Pollution or smog
The severity and length of asthma attacks vary. In extreme cases, asthma attacks can be fatal. Most people with asthma need to carry a rescue inhaler to get their attacks under control. Rescue inhalers contain a fast-acting bronchodilator that opens up the airways, making it easier to breathe.
COPD is a progressive disease, which means it gets worse over time. Like people with asthma, people with COPD experience shortness of breath, coughing, and wheezing. COPD, however, produces progressive changes in the airways that make it more difficult for a person to breathe. Unlike with asthma, these symptoms do not come and go.
In COPD, the tiny air sacs in the lungs become less elastic, making it difficult for the lungs to take in oxygen. The air sacs may also become inflamed, making breathing even more difficult.
People with COPD also typically produce more mucus in the airways and breathing tubes. This mucus makes breathing even harder because it partially clogs the airways.
Rather than a single disease, COPD is actually a group of disorders that make breathing difficult. The primary forms of COPD are:
- Emphysema, which inflames the air sacs and causes them to lose their shape. This results in larger air sacs, making it more difficult for the lungs to exchange the gases necessary for breathing.
- Chronic bronchitis: Chronic bronchitis increases the quantity and thickness of mucus in the airways. Like acute bronchitis, chronic bronchitis causes coughing, shortness of breath, and difficulty breathing. Chronic bronchitis gets worse over time and is persistent.
In many cases, people with COPD have both disorders.
According to the Asthma and Allergy Foundation of America (AAFA), the American Disabilities Act (ADA) and Section 504 state that having a mental or physical impairment that severely limits one or more life activities, including breathing, can be considered a disability.
For people with asthma, this applies even if symptoms only show at certain times, and if the person uses medication, such as an inhaler, to control the problem.
To qualify for social security disability benefits with COPD, a person must have:
- A forced expiratory volume one (FEV1) that is the minimum for your height or less, from 1.05 to a person who is 5 feet tall to 1.65 to someone who is 6 feet tall.
- Chronic impairment of gas exchange resulting from a documented COPD.
Those who do not meet these requirements may be able to get other types of help, such as as medical-vocational allowance for people on a low income.
A spirometry test, or pulmonary function test, can measure how well the lungs work. Individuals blow into the device as hard and as long as they can, providing information about how much air the lungs take in and expel. Many doctors use spirometry tests to measure airway problems associated with COPD and asthma.
Factors doctors look at when weighing a diagnosis with COPD or asthma include:
- A history of smoking: Most people with COPD are or were smokers.
- Age: Asthma often appears in childhood. If breathing difficulties occur after the age of 40, doctors are more likely to diagnose COPD.
- Symptoms: Coughing in the morning, heavy phlegm, and progressively getting worse suggest COPD. Recurring attacks, particularly if accompanied by allergies or eczema, suggest asthma.
- Family history: Asthma is more likely to run in families.
- Symptom triggers: People with COPD may have symptoms when they are active or at rest, without a known trigger. Asthma attacks may be caused by physical activity or something in the environment.
- Onset of symptoms: COPD tends to get worse over time, while asthma attacks come on suddenly.
- Responsiveness to treatment: Asthma tends to respond better to quick acting rescue inhalers than COPD does.
Though a medical history may help differentiate asthma from COPD, research increasingly points to significant overlap between the two. A 2016 study published in Chest found that 15 percent of people with COPD also have symptoms of asthma. This condition is called asthma-COPD overlap syndrome (ACOS).
Diagnosis with either condition doesn't rule out developing another breathing disorder, so patients should report all symptoms to their doctor.
Is chronic asthma the same as COPD?
Chronic asthma and COPD can have similar symptoms, but they are considered distinct conditions. COPD refers specifically to chronic bronchitis, emphysema or both.
Other differences include the fact that asthma tends to start during childhood, while COPD is more likely to appear among adults who smoke.
Other disorders with similar symptoms
A number of other disorders can cause breathing difficulties, so it's unwise to self-diagnose with either COPD or asthma.
Other disorders associated with breathing difficulties include:
- Upper respiratory and sinus infections
- Cancer of the lungs or throat
- Infectious diseases, such as histoplasmosis and tuberculosis
- Cardiovascular disease
- Blood clot in the lungs
- Problems with heart valves or heart structure
- Collapsed lung
Asthma is one of the most common chronic medical conditions, affecting 25 million people in the United States. Asthma typically appears in childhood, and is more common among people with a family history of either asthma or allergies. Other risk factors for asthma include:
- Exposure to air pollution
- A history of viral respiratory infections
- Exposure to dust, chemical fumes, and mold
- Skin conditions, such as hives and eczema
- Exposure to air pollution
- Secondhand smoke
- Dust and chemical fume exposure
- A rare genetic variant called alpha-1 deficiency, where the alpha-1 protein that helps protect the lungs is produced in abnormally low amounts
Asthma and COPD are chronic conditions that do not have a cure. Treatment aims to control symptoms. Breathing difficulties associated with both asthma attacks and COPD often require the combination of short acting and long acting inhalers.
If allergies are a trigger, allergy treatment may also help. Some people with asthma or COPD take long-acting bronchodilators - medications that reduce inflammation in the airways - making it easier to breathe.
Lifestyle remedies may also help. Avoiding exposure to allergens, quitting smoking, getting exercise, and avoiding illnesses such as the flu may reduce symptoms of both disorders.
Doctors may recommend having the flu, whooping cough, or pneumonia vaccine to decrease the risk of getting these infections. Other vaccinations may be important as well.
As COPD progresses, managing symptoms becomes more difficult. Some people with COPD need oxygen to breathe. The disease can be fatal, and is the third leading cause of death in the U.S.