COPD VS Asthma: Is It Asthma Or COPD?

Figure Out If You Have Asthma Or COPD.

Senior man about to use asthma inhaler
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When you ask yourself "Do I have COPD or asthma?" there are actually a number of questions that may help you answer the question. This is not an uncommon question or problem.

Unfortunately, COPD has a certain stigma in our society that many patients do not like. As a result, some patients with COPD will say they have asthma. Both diseases can lead to the following symptoms:

However, while the symptoms may be similar, there are enough differences that it is an important distinction to make.

Determining If It's Asthma or COPD

Answering the following questions will help you know which one is impacting you:

Did I have symptoms of allergy or asthma as a child? While some patients are diagnosed with asthma in adulthood, most asthmatics are diagnosed in childhood or adolescence. In fact, a number of studies have shown that primary care doctors will often label older patients with asthma when in fact they have COPD. While COPD can be a llong-termcomplication of poorly controlled asthma, COPD is rarely diagnosed before the age of 40.

What makes my symptoms worse? Asthmatics can often identify what it is that worsens their symptoms. Things such as:

COPD, on the other hand, is often made worse by respiratory tract infections and not any of the previously mentioned asthma triggers.

Do I smoke? While COPD and asthma may occur together, COPD is more common in current or former smokers and those exposed to environmental tobacco smoke. While COPD can occur in patients that have never smoked, greater than 80% of patients with COPD smoked in the past or are current smokers.

Am I ever symptom free? Patients with asthma experience symptoms intermittently, are relatively symptom free between asthma exacerbations, and experience significant periods of time without symptoms when their asthma is under good control.

COPD patients, on the other hand, experience progressive symptoms and rarely go a day without symptoms.

Does my lung function return to normal between exacerbations? In both asthma and COPD your doctor will measure certain aspects of your lung function with spirometry such as FEV1. With asthma, treatment returns your lung function to normal or near normal and you should not have many asthma symptoms between asthma exacerbations. On the other hand, a COPD patient's lung function will generally not return to normal and only partially improves even with smoking cessation and bronchodilator treatment. In fact, even with smoking cessation COPD patients may still experience a decline in lung function. This decline usually leads to stmptoms such as shortness of breath that often are why the COPD patient is seeking care. Once a COPD patient develops symptoms, symptoms are generally chronic. Over time COPD patients tend experience symptoms that are not typical for asthma- losing weight, decreasing strength, endurance, functional capacity and quality of life.

Do Some Patients Have Asthma and COPD?

COPD patients, however,  are increasingly noted to have an asthma component in addition to their COPD. Surprisingly, 1 in 4 asthma patients smoke and are at risk for COPD like any other smoker.

Some COPD patients demonstrate asthma like reversibility on pulmonary lung function testing referred to as an "asthma component." If reversibility is not present, no asthma component exists. The American Thoracic Society defines reversibility as  a post-bronchodilator increase in FEV1 of at least 12% for both COPD and asthma. When reversibility is present, it is generally less in a COPD patient compared to a patient with only asthma.

Sources:

Tinkelman DG, Price DB, Nordyke RJ, Halbert RJ. Misdiagnosis of COPD and asthma in primary care patients 40 years of age and over. J Asthma. 2006 Jan-Feb;43(1):75-80.

Kuebler KK, Buchsel PC, Balkstra CR. Differentiating chronic obstructive pulmonary disease from asthma. J Am Acad Nurse Pract. 2008 Sep;20(9):445-54.

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