How Do You Know If It Is Asthma or COPD?

It's Not Always Easy To Tell

Is it asthma or COPD? It’s not always easy for you or your doctor to tell.

A reader recently wrote too me confused by something her doctor told her. She writes:

“My pulmonologist diagnosed me with chronic obstructive asthma. When I google that term, COPD comes up.  Does that mean I have COPD as well as asthma?  I am a 54 y.o woman who never had asthma as a child.  I developed problems with my lungs following a bad cold this past winter.

  I’ve never smoked cigarettes.  I have asthma symptoms almost every day.

My medications are ProAir for a rescue inhaler, Symbicort BID, Singulair HS and I am using my home nebulizer BID also.  

I was hospitalized two weeks ago for an asthma attack for three days and received IV steroids and nebulizer treatments every 8 hours and was discharged on a prednisone taper starting at 40 mg for 3 days.  When I had the severe asthma attack that sent me to the ER, I was already tapering off prednisone.”

So does she have asthma, COPD, or both. Answering a number of questions may help determine if it is asthma or COPD. A small number of patients may also have a mixed picture.

Did I Have Symptoms as a Child?

Some people develop symptoms and are diagnosed with asthma in adulthood. However, asthma most occurs in children and adolescents. In fact, many older patients diagnosed with asthma really have COPD.

What Makes My Asthma Symptoms Worse?

While asthma and COPD both have obstruction, inflammation, and airway hyperresponsiveness as part of the disease process, asthma is primarily an allergic disease and patients often know what makes their symptoms worse such as:

COPD is not usually triggered, but is often made worse by respiratory tract infections.

Do I Smoke?

While smoke may trigger asthma symptoms, COPD is more common in smokers, former smokers, or patients exposed to passive smoke.

Do I Have Any Symptom Free Periods?

Asthma symptoms are intermittent, reversible, and lung function tests (e.g. FEV1 and spirometry) either return to normal or significantly improve between asthma exacerbations. Symptoms with COPD, on the other hand, are irreversible and often progressive. Most COPD patients experience regular if not daily symptoms.

Could You Have Mixed Disease?

Although not well studied, doctors are increasingly acknowledging a mixed disease process. These physicians believe in what is called the “Dutch hypothesis” where asthma and COPD are on the same disease continue rather than being separate, distinct diseases. The hypothesis promotes the idea that disease in the adult lung is the product processes developing and progressing throughout childhood.

Patients with overlap are generally older. Most commonly these patients are either:
1. smokers with asthma
2. nonsmokers with long-standing asthma that progresses to COPD

On functional testing overlap patients have disease that partially behaves like asthma and partially like COPD.

What Is Your Biggest Asthma Problem?

We want to help you get control of your asthma. I want to hear about your biggest asthma problem so that we can try to help you develop a solution or better understand how to help.? You are probably not the only one with the problem. Take a few minutes describing your problem so we can develop a solution together.


N. G. M. Orie. The Dutch Hypothesis.

National Heart, Lung, and Blood Institute. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma.

Papaiwannou A et al. Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS): current literature review.. J Thorac Dis. 2014 Mar; 6(Suppl 1): S146–S151.

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