Asthma or COPD: What is the difference? Easy Tips!
Asthma or COPD? This question arises in many minds when dealing with a patient with wheezing.
Asthma and COPD are two different conditions but have many clinical symptoms in common such as cough, wheezing, and breathlessness. These similarities in symptoms and signs lead to confusion among junior doctors about whether they are dealing with asthma or COPD. There may be an overlap of asthma and COPD in some cases, but in the majority, there is no overlap. It is important to differentiate the two conditions because treatment & disease courses are different for each.
Here are some differentiating features between asthma and COPD.
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Age
Asthma usually presents before 40 years of age, most commonly in adolescence.
COPD presents after 40 years of age. An exception could be genetic deficiency of alpha-1 antitrypsin deficiency, which may present earlier.
Pathology
Asthma is due to airway hyper-responsiveness (AHR), while COPD is caused by inflammation and damage of distal airways and alveoli caused by smoke/noxious gases.
Atopy
A history of atopy is commonly found in atopic asthma patients (intrinsic asthma).
Atopy is absent in COPD.
Family history
It is usual to find a positive history of asthma in the family.
There is no family history of COPD in COPD patients.
Smoking
There is a strong causal relationship between COPD and cigarette smoking, usually with 10 or more pack years of smoking. Furthermore, COPD can also be caused by chronic exposure to environmental pollutants or occupational dust.
On the other hand, smoking and asthma have no causal relationship.
Clinical features
Symptoms of asthma are intermittent and variable, while in COPD, the symptoms are usually persistent.
Cough & Sputum
Cough is a common feature of both diseases.
Cough is more commonly nocturnal in asthma, while it is persistent in COPD.
Furthermore, cough in asthma is usually productive of scanty sputum, while it is characteristically productive of copious sputum in chronic bronchitis.
Diurnal variation
Asthma symptoms exhibit diurnal variation. Symptoms are more pronounced at night and early morning. Peak expiratory flow readings show an early morning dip, that improves over course of the day.
COPD symptoms have no diurnal variation.
Triggers of acute episodes
In cases of asthma, the usual triggers include allergens like pollens, house dust mites, animal dander, or exposure to cold, and exercise in exercise-induced asthma.
COPD triggers are infections and environmental pollutants.
Status between acute episodes
Asthmatics are symptom-free between attacks, while COPD patients are usually symptomatic.
Reversibility
This is the most objective differentiating point. On spirometry, asthma patients show reversibility, while there is no reversibility in COPD after steroids or bronchodilator use.
Steroid responsiveness
Asthma patients are steroid responsive, while the response is weak in COPD patients.
Hyperinflated Lungs
Hyperinflation of the lungs is common in COPD, while in asthma patients it may appear in advanced disease only.
Eosinophils & IgE levels
Eosinophilia and raised IgE may be commonly found in atopic asthma, while these are not raised in COPD.
Disease course
Asthma has usually a stable course with intermittent exacerbations. COPD shows a progressive worsening course, especially in those who continue to smoke or who remain exposed to noxious gases or dust.
