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Tuesday, June 2, 2009

Asthma or COPD: Which one do you have?

Many times in the course of my job as an RT, and now a few times on these pages, I am asked what the difference is between COPD and Asthma.

They do have many things in common, as they both are diseases of the direst suffering. They both cause stress, distress and anxiety for those suffering from it. Yet, they also both cause anxiety for family members of those suffering from these diseases.

Yet, as my fellow asthma experts and I explain in this this Q&A, while these diseases may be similar in that they both cause episodes of air trapping, the mechanisms involved with both diseases are unique. Likewise, the effects of these diseases on the patient is unique as well.

So, that in mind, I thought would provide some basic definitions here to help my readers understand the difference between Asthma and COPD.

Asthma: This is a disease of chronic inflammation of the air passages (bronchioles) of the lungs, and is associated with acute episodes bronchospasm leading to shortness-of breath that is reversible with time and/or medicine.

While their lungs are chronically inflamed, an asthmatic can go days, weeks, months, even years without symptoms.

Because of the chronically inf lammed airways, when an asthmatic is exposed to his asthma triggers, his lungs swell up even more, produce excess sputum, and become narrowed (bronchoconstriction). In other words, the airways are sensitive or "twitchy" to asthma triggers resulting in spasms of the air passages in the lungs (bronchospasm). This results in air becoming trapped inside his lungs, making him feel like a fish out of water during these episodes.

These acute episodes of bronchospasm can be treated with either time or medicines such as beta-adrenergic medicines like Ventolin and Xopenex. They can also be treated by controlling the inflammation with anti-inflammatory medicines like corticosteroids.

With new anti-inflammatory medicines like Advair and Singulair, this chronic inflammation can be controlled so that episodes of asthma are "prevented" and/ or easier to treat.

Asthmatics generally do not need to use oxygen, and it is rare that oxygen levels decrease except for in severe episodes. Therefore, oxygen is not needed outside of hospitals.

While we know what triggers asthma, and we do suspect it is a genetic disorder, what causes a person to develop asthma is unknown (although there are theories).

Chronic Obstructive Pulmonary Disease. According to, 80% of current COPD cases are caused by smoking, however they can be caused by inhaling other hazardous chemicals. There are three types of COPD: Emphysema , chronic bronchitis and in some cases Hardluck Asthma. COPD is not reversible, although if a person is removed from the exposure of hazardous chemicals (i.e. stops smoking), the disease may stop progressing.

Oh, and by the way, yes you can get COPD from second hand exposure to smoke. I have a few patients who have never smoked in their lives yet still have this disease.

And, yes, you can get COPD from second hand exposure to smoke.

Most COPD patients have some degree of dyspnea on a daily basis, which may be partially reversible with beta-adrenergic and corticosteroid therapy.

As the disease progresses, many will require oxygen usage at home.

Emphysema: Basically, this is where a person is exposed to hazardous chemicals (Alpha 1-antitrypsin deficiency) and therefore tissue in the lungs literally erodes away. According to

  • The walls of the alveoli become inflamed and damaged; over time they lose elasticity (the ability to stretch and shrink), and pockets of dead air (called bullae) form in the injured areas.
  • These pockets are formed by damaged alveoli that merged, and have become irregular in shape.
  • The pockets interfere with the normal working of the lungs, making breathing out more difficult.
  • Inhalation (breathing in) is not impaired. Until the late stages of the disease, oxygen and carbon dioxide levels are normal.

The result here is, as the disease progresses, the person has less and less lung volume to work with. In many cases, these patients are thin smokers, are pink, and due to the loss of lung elasticity, their shoulders are always high and hunched. We RTs refer to them as pink puffers.

Chronic Bronchitis: This is a disease where a person is exposed to hazardous chemicals (mostly cigarette smoke, but not always) and this results in a loss of cilia that is normally in the airways and is used to bring up sputum. As the disease progresses, sputum becomes trapped in the patients lungs, making it difficult for these people to expectorate. They quite often develop a chronic cough (smokers cough). As a result, they become highly prone to lung infections such as pneumonia.

According to

  • Irritation of the bronchial tubes (from smoking, air pollution, etc.) causes mucus production. The mucus is cleared through coughing.
  • Constant coughing causes damage to the bronchial tubes. The tubes swell and thicken, leaving less room for air flow.
  • The reduced airflow into the lungs usually leads to lung damage that results in emphysema.

If I had a choice between these three diseases I'd much rather have Asthma because not only is reversible. While asthma attacks can be preventable with new asthma controller medicines, COPD is also preventable in most cases by simply staying away from hazardous chemicals, or by not smoking or not being in the presence of those who do smoke.

Usually asthma is caused in your youth, so most people who get it have adjusted to that lifestyle before they become an adult. However, adult onset asthma may be equally frustrating as COPD, because it requires a person to change his lifestyle, which may be extremely difficult.

Like asthma, COPD can be controlled if the person quits smoking, avoids living in places that irritates his breathing, is compliant with his medicine, and eats right.

Most mild and moderate asthmatics can live a normal life if their asthma is treated appropriately. If a patient who is diagnosed with COPD quits smoking in the initial stages of the disease, life expectancy can be normal. While it is not possible for the lungs to regenerate tissue, further damage can be spared.

However, if COPD is diagnosed in the later stages, or if a person refused to quit smoking, the disease may progress and result in a shortened lifespan.

So, there you have it. Now you know the difference between COPD an d Asthma. If you'd like to learn more check out or Stopsmoking/