Asthma Or COPD? How To Tell The Difference

Asthma and chronic obstructive pulmonary disease (COPD) are two of the most common respiratory conditions affecting Americans today. While both conditions impact breathing, their causes and long-term outlooks can be very different. Thanks to evolving treatments and new technologies, asthma and COPD patients now have more options than ever, many offered close to home at Franciscan Health.

Board-certified interventional pulmonologist Faisal Khan, MD, an independent provider who chooses to practice at Franciscan Health Indianapolis, discusses how asthma and COPD are similar and different, and how these lung conditions can be treated and managed today.

Key Takeaways: Asthma Vs. COPD

• Asthma and COPD are both obstructive lung diseases that narrow the airways and cause symptoms like coughing, wheezing, chest tightness and shortness of breath.
• Treatment for these lung diseases has advanced beyond inhalers, including injection therapies for severe asthma and specialized medications and procedures for COPD.
• Pulmonary rehabilitation significantly improves breathing, stamina and quality of life for people with both respiratory conditions.

How Are Asthma And COPD Alike?

Dr. Khan says although the public often confuses asthma and COPD, the two respiratory conditions share a similar foundation.

“At the fundamental level, there is similarity in the physiology of the disease,” he said. “Both the disease processes belong to a category of disease, what we call obstructive lung disease.”

Obstructive lung diseases

Obstructive lung diseases narrow the bronchial tubes, making it harder for air to pass through. This causes common symptoms such as cough, chest tightness, wheezing and shortness of breath.

Common symptoms for asthma and COPD

According to the American Academy of Allergy, Asthma & Immunology, common symptoms of asthma and COPD are shortness of breath and cough. With COPD, that cough may accompany phlegm. With asthma, wheezing and chest tightness may be more common with the cough.

Similarities in treatments for asthma and COPD

“Inhalers are commonly used for both,” said Dr. Khan. “Inhalers do impact COPD and help relieve symptoms, but the magnitude of improvement may not be as robust as what you see in asthma because the driving forces and the changes in the airway walls are different.”

Asthma Vs. COPD: What Are The Differences?

Patients typically have either asthma or COPD, but sometimes a person may have both conditions. This can be known to as asthma-COPD overlap syndrome.

Respiratory triggers  

Asthma is driven by airway sensitivity often triggered by environmental factors such as dust, cold air, perfume or heat.

“Asthma is usually the sensitivity of our airways to different stimuli,” Dr. Khan said. “Now, one of the key features of the asthma is that majority of that constriction or narrowing is reversible, meaning if you avoid the trigger or use medicine, the airway will open back up almost to normal caliber or if not even back to normal. It'll show a good response to what we call bronchodilator medications.”

In contrast, COPD is a fixed narrowing of the airway and gets worse with time. COPD most commonly develops after years of smoking, which leads to chronic airway inflammation and scarring.

“The scarring is generally not reversible,” Dr. Khan said. “So, as the airways get scarred and narrow, that narrowing of the caliber is more of a fixed narrowing than compared to asthma where there's some reversibility. Now, having said that, there is some reversibility in the COPD narrowing as well, but it's not as profound as you see in asthma.”

Symptoms

While coughing is a common symptom for both asthma and COPD, there are key differences:

How Can Treating Asthma And COPD Be Similar Or Different?

For many years, treatment for both asthma and COPD centered around inhalers designed to relax or open the airways. Today, medicine has expanded beyond that.

Advancements in asthma treatment

Over the years for asthma, the focus has been more on chasing the molecular pathways that drive the common form of asthma.

Injections for environmental triggers

Allergic asthma, which is often triggered by a sensitivity to environmental triggers, may be treated in part through injections that target the inflammatory response.

“By targeting the root cause of the main derivative of inflammation, you in turn impact the load of inflammation in the airways and also reduce the sensitivity of the airways to the trigger,” Dr. Khan said. “So, you're not going to twitch the airway to the same amount when exposed to the same trigger as you would be if you had a higher eosinophil count.”

The injections that are targeting these fundamental molecular pathways have made a huge difference in people who have had severe asthma and are an alternative to long-term steroid therapy.

“Steroids are helpful because they cut the inflammation, but they come with a whole baggage of their long-term side effects like weight gain, diabetes, bone loss and blood pressure issues,” said Dr. Khan. “There's been this evolution of different shots that are now available with some nuances of which one is better for which patient, but the fundamental is they target the underlying molecular pathways. And from that standpoint, we have seen a lot of progress.”

Bronchial thermoplasty

For people who have severe asthma that is just not controllable by any medication, or if they cannot take these newer medications, a new treatment option called bronchial thermoplasty can help. The procedure targets the smooth muscle wall or the smooth muscle layer in the walls of the bronchial tubes.

“It was much more used before these immunologic shots came into the market,” said Dr. Khan. “The use has gone down, but the option is still FDA-approved.”

Advancements In COPD Treatment

COPD treatment options have expanded in recent years.

“Now, there are options if someone is not getting controlled on routine inhalers and the fundamentals,” Dr. Khan said. "If those are not working, then there are many more effective and safer options.”

New medication options

In the past, the main treatment option for COPD was using inhalers to help improve breathing.

“The inflammation drivers in the COPD are variable,” Dr. Khan said. “Some people with COPD have the same cells that drive their COPD and bronchoconstriction as asthmatics. So, the eosinophils do play a role, not in everyone, but in some.”

Other treatment options that have come for those living with COPD include oral or inhaled medications that target a different pathway.

“They fundamentally are more useful for people who have a lot of what we call productive cough, or predominantly bronchitis compared to emphysema,” Dr. Khan said. “Those are both different kind of nuances within the bigger picture of COPD.”

Lung volume reduction

Procedures to help people with COPD have evolved as well.

"Emphysema by default is where people with COPD have a lot of these empty pockets in the lung and those pockets have air trapped in them. That is wasted air, just taking the space without contributing to the oxygen exchange,” Dr. Khan said. “That also causes stretching of the lung because those are big pockets of air, empty air pockets in the lung. That stretches the surrounding muscles and structures. It puts people at mechanical disadvantage in terms of using their respiratory muscles for breathing.”

In lung volume reduction, a physician identifies areas in the lung that had the most wasted air pockets or are diseased and removes them. This has evolved from surgery with incisions to a bronchoscopic approach that has no incision involved.

"You block those areas by putting one-way valves, which does not allow the air to go into those segments and causes a collapse of those segments,” Dr. Khan said. "Air can be redirected towards the healthier segments. It reduces the volume of the lung, which helps bring the muscles back to the more advantaged position in the chest wall muscles, and the diaphragm comes back because you're not overstretched. And that helps in terms of sensation of breathing, quality of life."

How Can Pulmonary Rehabilitation Help Asthma And COPD?

Pulmonary rehabilitation is one of the most effective tools available for people living with COPD and asthma. While many patients think first about inhalers or medications, pulmonary rehab offers benefits that reach far beyond breathing exercises.

According to Dr. Khan, “what pulmonary rehab does, it targets all aspects.”

He explains that patients enrolled in pulmonary rehab receive comprehensive support, including:

• Education on inhaler use:“They will be educated about proper use of their inhalers.”
• Smoking cessation counseling: “They will be counseled for smoking cessation and discuss techniques of how they can wean themselves off the cigarettes.”
• Exercise and muscle strengthening: “It’ll focus on certain specific exercises that help improve the stamina and also strengthen the muscles that help us breathe.”
• Airway clearance techniques: “It'll also educate them about clearance techniques, how to bring up the phlegm and clear their lungs.”
• Emotional and peer support: “The impact of seeing other people in a rehab program going through the same thing… is reassuring for patients, that they're not the only one. And they see success stories that has an impact on the mood and all that.”

The data on pulmonary rehab is clear and powerful. Dr. Khan explains, “what the data objectively shows is that when someone goes through rehab it reduces their sensation of breathlessness. It improves their stamina, it improves their quality of life.”

He adds that pulmonary rehab “improves the risk of flare-ups or exacerbation, actually reduces it. It reduces hospitalization.”

Despite all these benefits, pulmonary rehab remains underused as a resource for people living with asthma or COPD.

“It's very underutilized,” Dr. Khan says, noting that many patients and providers default to inhalers alone. But he emphasizes that pulmonary rehab should not be overlooked. “I cannot overstate the importance of it. It's really important for people with symptoms who have COPD.”

What Advice Do You Have For Patients Living With Asthma Or COPD?

Dr. Khan offers several key recommendations for people living with asthma or COPD.

Quit smoking

“If you are a smoker, really think hard about quitting smoking,” he said. “There are strategies available.”

Manage lifestyle

He also encourages patients to understand triggers, maintain a healthy lifestyle, manage stress and review inhaler techniques with their care team.

“One of the biggest areas where we find challenges, especially in older patients, is their technique of using the inhalers,” Dr. Khan said. “You may be using it in your mind, but you're not delivering the drug to the lungs because your technique is wrong.”

Explore treatment options

Today’s wide range of treatments provides real hope for those struggling with managing asthma or COPD symptoms. Talk to a Franciscan Health pulmonologist about the best COPD or asthma treatment options for you.