Asthma and COPD (Chronic Obstructive Pulmonary Disease), which includes
emphysema and chronic bronchitis, are common respiratory ailments that can
affect people for many years. Asthma can affect people at any point in
their lives, whereas COPD more often impacts seniors. Asthma and COPD also
can coexist in the same individual. It is important to understand the
similarities and differences between the diagnosis, treatment and
long-term outcome of asthma and COPD.
Asthma and COPD have very different definitions. Asthma is now
believed to be a disease of long-term inflammation, sort of like a rash in
your lungs. Like a rash, the lung inflammation in asthma can be triggered
by contact with substances that trigger allergies. Common allergic
triggers in asthma include house dust mites, cockroaches, molds, pet
danders and pollens. The lung inflammation in asthma is best treated with
anti-inflammatory medications, such as inhaled corticosteroids. Finally,
asthma is similar to a rash in that, when treated properly, the
inflammation may improve. Similar to asthma, patients with COPD have some
long-term inflammation. However, in contrast to asthma, the inflammation
is not triggered by allergies and does not respond well to
anti-inflammatory medication. In fact, the lungs of patients with COPD
have evidence of permanent damage with destruction and plugging of the
Asthma and COPD can both cause chest symptoms such as shortness of
breath, coughing and wheezing. Patients with asthma are more likely,
however, to have episodic chest symptoms, nighttime chest symptoms and
chest symptoms after exposure to allergic triggers than patients with
COPD. In contrast, patients with COPD are more likely to have a daily
morning cough that produces mucus and persistent chest symptoms throughout
Smoking causes damage under any circumstances. A long-term history of
smoking is very common in patients with COPD, and continued smoking
worsens the permanent lung damage in these patients. Patients with asthma
also worsen with smoking. Many patients with co-existent asthma and COPD
have had asthma for many years and cause the additional permanent lung
damage of COPD by smoking.
Your doctor is more likely, while listening to your chest, to hear
wheezing with asthma and is more likely to hear "distant" or reduced
breath sounds with COPD. Also, a "barrel chest," or barrel-shaped chest
due to the trapping of air, is more characteristic of COPD than asthma.
Chest X-rays may be normal in both asthma and COPD. When abnormal
findings are identified, these findings may include evidence for too much
air in the lungs (air trapping), which is usually more pronounced in COPD
than asthma. COPD patients may also show "increased lung markings."
Allergies are common in patients with asthma and may be confirmed through
allergy testing. In contrast, allergies appear to have nothing to do with
One of the most important tools your doctor may use to differentiate
between asthma and COPD is the pulmonary function test (PFT). In both
asthma and COPD, the PFT may show evidence for airway obstruction.
However, in asthma, but not in COPD, the PFT may show improvement in
obstruction after treatment with a bronchodilator, such as albuterol. In
patients with both asthma and COPD, obstruction improves with a
bronchodilator, but not to the same degree as with asthma alone.
Since asthma is often triggered by allergies and COPD is closely
associated with smoking, controlling for allergies and quitting smoking
can be very helpful in managing these diseases. Asthma is more of a
lung-inflammation illness, while COPD is more of a lung-destruction
illness. Therefore, anti-inflammatory medications, such as inhaled
corticosteroids are the best long-term treatment for asthma but are not
very beneficial for COPD. Both asthma and COPD can be treated with
bronchodilators that help the airways to relax and "open up." Your
physician is the most qualified individual to help you decide upon proper
treatment. Please see your physician regularly to help you with your
asthma and/or COPD.
The expected treatment goals of asthma and COPD may be very different.
Many patients with asthma, once the lung inflammation is treated, can be
virtually symptom-free. In contrast, most COPD patients have permanent
lung damage. Many with COPD can experience some improvement in symptoms
with treatment but the primary treatment goal is usually to slow the
further loss of lung function. For individuals with both asthma and COPD,
the expected outcome is an improvement in lung function but not to the
degree as with asthma alone.
Brian A. Smart, MD, is a member of the American Academy of Allergy,
Asthma and Immunology (AAAAI) and practices in a group allergy and asthma
practice in Buffalo Grove, IL.
Source: Copyright 2001, Asthma Magazine Reprinted by permission.