COPD versus asthma: What’s the difference?

You have a nagging cough, tightness in your chest, and make a wheezing sound sometimes when walking up the stairs. Those symptoms may have you wondering if you have asthma.

It could be. But it might also be a sign of a serious condition called chronic obstructive pulmonary disease (COPD).

COPD refers to a group of diseases that causes swelling of the airways, making it harder to breathe. And lots of people have it — nearly 15 million Americans, according to the Centers for Disease Control and Prevention. COPD is the sixth-leading cause of death in the US.

If you do have COPD, it’s important to catch it early. Here’s what you need to know about symptoms and treatment — and how it’s different from asthma.

The COPD-asthma connection

“Asthma and COPD have very similar symptoms and can mimic each other, confusing patients and their doctors,” says Lingye Chen, MD. She’s a lung specialist with Duke Allergy and Pulmonary in Durham, North Carolina.

Even more confusing: Some lung disease patients may have overlap of both asthma and COPD, according to the American Lung Association (ALA). This is known as asthma-COPD overlap syndrome.

Your best chance of managing COPD is by identifying it early. With asthma, lung damage can usually be reversed. “With COPD, airway obstruction is permanent and doesn’t get better easily,” says Richard Castriotta, MD. He’s a lung specialist at the University of Southern California’s Keck School of Medicine.

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What causes COPD?

One of the biggest differences between COPD and asthma is what causes them.

Between 85% and 90% of COPD cases are caused by long-term exposure to cigarette smoke, per the ALA. This is true if you smoke or if you’re often around others who smoke. COPD is also caused by regularly breathing in pollution or chemicals at home or at work.

Asthma is caused by triggers such as allergens (e.g., pollen or animal fur), chemical irritants, air pollution and cigarette smoke. You are also more likely to develop asthma if you have a family history of the disease or if you had respiratory problems as a child.

What are the symptoms of COPD?

COPD is a sneaky disease, Dr. Castriotta says. You can develop it long before the first symptom crops up. And even then, symptoms such as shortness of breath are sometimes chalked up to getting older or being out of shape. “Many people with COPD aren’t diagnosed until after age 50,” Dr. Chen says.

Emphysema and chronic bronchitis are the 2 most common conditions that contribute to COPD. Most patients have both at the same time, according to the Mayo Clinic.

COPD symptoms include:

• Shortness of breath
• Wheezing
• Chest tightness
• Constant cough with phlegm
• Regular respiratory infections
• Lack of energy
• Swelling of the ankles, feet or legs

Asthma symptoms are similar. But they are often seasonal, and they tend to come and go. COPD symptoms are usually there all the time, Dr. Chen says.

COPD symptoms aren’t always at the same level. They can suddenly get worse. This is called a flare-up. Causes of a flare-up include:

• Lack of sleep
• Stress
• Too much activity
• Being sick
• Weather changes

It’s important to treat COPD before more damage is done. “Patients who are or were smokers and develop symptoms of cough, phlegm, shortness of breath or wheezing should see their doctor,” Dr. Chen says.

How do doctors diagnose COPD?

COPD can be diagnosed with several tests. One option is a breathing test known as a pulmonary function test. It measures how well you breathe in and out. And it can tell your doctor how much oxygen your lungs move from the air into your red blood cells, Dr. Castriotta says. Another option is a CT scan of the chest.

Your doctor might also want to rule out asthma. If so, they will have you take a medicine called a bronchodilator. And then you’ll take a breathing test called a spirometry test.

Come ready for your appointment by bringing your medical and family health history.

As for COPD, your doctor will want to know about your history of cigarette smoking or chemical exposure.

What’s the best way to treat COPD?

Your first step is to quit smoking. This is the best way to prevent further lung damage. If you don’t smoke, it’s important to stay away from secondhand smoke or other chemicals.

“Physical exercise, particularly aerobic exercise, is also very beneficial in keeping the heart and lungs healthy,” Dr. Chen says. Try activities such as taking a brisk walk, riding your bike or taking a group fitness class. Staying up to date on vaccinations is key, too.

There are also other treatments that can make COPD more manageable.

Bronchodilators: These are medications that usually come in inhalers. They work by relaxing muscles around the airways. And they can help ease coughing and shortness of breath. There are 2 types of bronchodilators:

• Short-acting. Use these before you exercise. A common short-acting bronchodilator is albuterol (ProAir HFA, Ventolin HFA).
• Long-acting. Use these forms every day. Long-acting types include tiotropium (Spiriva) and salmeterol (Serevent).

Inhaled steroids: These medications can help cut inflammation in the airways. That makes COPD symptoms easier to manage. Inhaled steroids include medications such as fluticasone (Flovent HFA) and budesonide (Pulmicort Flexhaler).

Breathing exercises: You can do simple breathing exercises at home to control shortness of breath, says the Cleveland Clinic. One example: pursed-lip breathing. To do it, close your mouth and breathe in through your nose for 2 slow counts. Then purse your lips and breathe out gently for 4 slow counts.

Pulmonary rehabilitation program: This is a supervised exercise program that helps you build your fitness. You’ll also learn nutrition tips and get emotional support from other COPD patients.

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Additional sources

COPD stats: Centers for Disease Control and Prevention (2021). “COPD”
ACOS stat: American Lung Association (2018). “When asthma and COPD overlap”
COPD causes: American Lung Association (2021). “COPD causes and risk factors”
COPD symptoms: Mayo Clinic (2020). “COPD”