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COPD vs. asthma: Which is worse?

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By | Mar. 18, 2021 Medically reviewed by Stephanie Melby, Pharm.D.
Inhaler and question mark: Compare COPD vs asthma

Key takeaways

  • Asthma and COPD are chronic lung diseases with similar symptoms like coughing, wheezing, and shortness of breath, but COPD is irreversible and worsens over time, while asthma can be managed and controlled.

  • The primary cause of COPD is smoking or long-term exposure to chemical irritants, whereas allergens and exercise often trigger asthma, which has a genetic component.

  • Diagnosis of both conditions involves pulmonary function tests such as spirometry, but COPD may also require chest X-rays or arterial blood gas tests, while asthma diagnosis can include allergy testing.

  • Diagnosis of both conditions involves pulmonary function tests such as spirometry, but COPD may also require chest X-rays or arterial blood gas tests, while asthma diagnosis can include allergy testing.

COPD vs. asthma causes | Prevalence | Symptoms | Diagnosis | Treatments | Risk factors | Prevention | When to see a doctor | FAQs | Resources

Asthma and chronic obstructive pulmonary disease (COPD) are diseases of the lung that have a lot in common, but they also have key differences. Both conditions have similar symptoms caused by swelling of the airways or airway obstruction. Airflow limitation commonly results in breathing difficulties, coughing, wheezing, chest tightness, and shortness of breath. 

Symptoms from asthma, triggered by allergens or exercise, come and go. COPD symptoms that can be caused by long-term smoking or prolonged exposure to chemical irritants are persistent. With COPD, chronic inflammation results in irreversible damage to the tissues lining the airways as well as pathological changes to the lung. 

Though both diseases are chronic, COPD is a progressive condition, meaning symptoms are constant and the condition gets worse over time. With asthma, measures can be taken to control the disorder and when managed properly, it’s possible not to experience any symptoms for extended periods of time. It’s important to distinguish COPD from asthma to determine the best course of treatment. Let’s investigate the similarities and differences between asthma and COPD.

Causes

COPD

According to the American Lung Association, 85% to 90% of COPD is caused by smoking. The toxins in cigarettes weaken the ability of the lungs to fight infection, constrict the air passages, cause inflammation and swelling, and destroy the tiny air sacs in the lungs, called alveoli. Environmental exposure to chemical irritants and toxins, including air pollution, can also cause COPD. A small number of cases can be attributed to a genetic condition that inhibits the body’s production of the lung-protecting Alpha-1 protein. This is called alpha-1-deficiency-related emphysema. 

There are two types of COPD: chronic bronchitis and emphysema. In both conditions, the lung’s airways thicken and become inflamed, causing tissues to die. When this happens, the exchange of carbon dioxide and oxygen within the body’s tissues decreases, causing shortness of breath and other complications. There’s no cure for COPD, but when caught early, it can be managed with a multifaceted approach to treatment. Here are the conditions in more detail:

  • Chronic bronchitis: Inflammation in the airways of the lungs, called the bronchi, causes irritation resulting in productive coughing spells with sputum, wheezing, shortness of breath, and chest pain. While the condition may improve or worsen over time, it will never go away completely, though treatment options are available to manage symptoms.
  • Emphysema: The lung’s air sacs, called alveoli, are damaged gradually over time. As emphysema progresses, the alveoli rupture, becoming a singular air pocket instead of many tiny ones, reducing the surface area of the lungs and trapping air in its damaged tissue. This impairs the movement of oxygen in the bloodstream and makes breathing harder.

Asthma

Asthma is a chronic inflammatory disorder of the airways caused by exposure to allergens or irritants that causes chronic inflammation. While not all causes of asthma are known, there can be a genetic component—it tends to be inherited. Exercise and allergens like dust, mold, or pollen and childhood exposure to irritants such as cigarette smoke can cause an asthma attack. Early childhood respiratory infections that result in impaired lung function may also contribute to asthma. In adults, exposure to chemicals and irritants at work can contribute to adult-onset asthma. Common environmental asthma triggers include: 

  • Tobacco smoke
  • Dust mites
  • Air pollution
  • Insects and Rodents
  • Pets
  • Mold
  • Chemical irritants
  • Influenza 
COPD vs. asthma causes
COPD Asthma
  • Environmental exposure to toxins and irritants
  • Cigarette smoking
  • Alpha-1 Deficiency
  • Environmental exposure to toxins and irritants
  • Exposure to environmental allergens 
  • Respiratory infections
  • Allergies
  • Genetics
  • Exercise

Prevalence

COPD

COPD affects an estimated 30 million Americans and is the 4th leading cause of death in the United States. In 2018, 2 million adults had emphysema, and 9 million had chronic bronchitis; over 16 million people were diagnosed with COPD, but it is estimated that many more undiagnosed COPD patients live with the disease. 

Asthma

According to the Centers for Disease Control and Prevention (CDC), 1 in 13 people in the United States has asthma. In 2018, just under 25 million Americans had asthma- 19 million adults and over 5 million children. Asthma is the leading chronic disease in children.

COPD vs. asthma prevalence
COPD Asthma
  • An estimated 30 million Americans have COPD
  • COPD is the 4th leading cause of death in the United States
  • 25 million Americans had asthma in 2018
  • Asthma is the leading chronic disease in children

Symptoms

COPD

In the early stages, COPD may exhibit as mild shortness of breath. As the disease progresses, people may experience a chronic cough (which brings up a lot of phlegm/sputum), persistent shortness of breath, wheezing, frequent respiratory infections, difficulty taking a deep breath, chest tightness and pain, fatigue, and cyanosis (blue lips and fingernail beds).

Asthma

The immune system’s inflammatory response to asthma triggers impacts the airways of people with asthma. When exposed to allergens and other triggers, people with asthma might have an asthma attack with coughing and wheezing, tightness in the chest, shortness of breath, and difficulty taking a deep breath. Airway hyper-responsiveness, a hallmark of asthma, involves increased sensitivity of the airways after being exposed to various irritants.

COPD vs. asthma symptoms
COPD Asthma
  • Coughing
  • Wheezing
  • Shortness of breath
  • Chest tightness
  • Difficulty taking a deep breath
  • Excessive mucus production
  • Frequent respiratory infections
  • Cyanosis
  • Fatigue
  • Chest pain
  • Coughing
  • Wheezing
  • Shortness of breath
  • Chest tightness
  • Airway hyper-responsiveness

Diagnosis

COPD

To diagnose COPD, a physical exam and a simple pulmonary function test called spirometry are performed to test how well the lungs are working. During the test, a person blows into a mouthpiece attached to a small tube connecting to a machine. The machine measures the amount of air and how fast a person blows air out. A doctor will evaluate the results to diagnose COPD. In normal adults, the ratio of FEV1/FVC (forced expiratory volume/forced vital capacity) is 70-80%. A value under 70% is a possible sign of COPD. Additional tests, such as a chest X-ray or arterial blood gas test to measure the blood’s oxygen level are helpful in determining how well the lungs exchange oxygen and carbon dioxide.

Asthma

For people who are experiencing symptoms like shortness of breath, frequent cough, chest tightness, or wheezing, a healthcare provider performs a few basic tests to diagnose asthma, starting with a health exam. Similar to testing for COPD, spirometry is conducted to evaluate lung function. Blood or skin allergy testing or a methacholine challenge test may be used to determine a person’s response to environmental triggers. A FeNo test measures exhaled nitric oxide, helping doctors tell how much inflammation is present and how effective inhaled steroids are at reducing the swelling.

COPD vs. asthma diagnosis
COPD Asthma
  • Spirometry
  • Chest X-ray
  • Arterial blood gas test
  • Spirometry
  • Blood or skin allergy testing
  • FeNo test
  • Methacholine challenge test

Treatments

COPD

Because COPD progresses over time, treatment involves managing symptoms. There is no one medicine that works best for all COPD patients, so it’s important to work with a doctor to come up with an effective treatment plan. Various medications, lung therapies, quitting smoking, controlling lifestyle and environmental factors, and staying up to date on vaccines can all be used as part of a treatment plan.

COPD medications

Medications for COPD include bronchodilators to relax the muscles around the airways, and can be either short-acting or long-acting. Short-acting medications are often used in exacerbations and long-acting are used for maintenance. Inhaled corticosteroids reduce inflammation in the airways, and combination inhalers have both a bronchodilator and corticosteroid. Inhaled bronchodilators and corticosteroids are available as inhalers, but some are also available in solutions to use with a nebulizing machine. Oral steroids, taken short-term, reduce lung inflammation caused by flare-ups. 

In acute respiratory infections such as bronchitis or pneumonia, antibiotics like Zithromax may be prescribed. Other medications, such as phosphodiesterase-4 inhibitors and theophylline, improve breathing by decreasing inflammation and relaxing the airways. 

Short-acting bronchodilators:

Long-acting bronchodilators:

Inhaled corticosteroids:

Combination inhalers:

Nebulization solutions:

Oral steroids:

Other medications:

Other COPD treatments

  • Smoking cessation is very important for COPD patients in order to stop the destruction of the lungs and prevent symptoms from becoming even worse. Quitting smoking has the biggest impact on the quality of life.
  • Controlling environmental exposure to toxins and avoiding COPD exacerbations, such as air pollution, toxic fumes, and other irritants is helpful in controlling COPD symptoms.
  • Healthy lifestyle changes through guided pulmonary rehabilitation programs include exercise, a healthy diet, and education about COPD to help people with the disease control their symptoms. 
  • Supplemental oxygen supplied via a portable tank or similar device may be needed if blood oxygen levels are too low. Oxygen therapy is the only proven way to prolong the lifespan of a person with COPD.

Asthma

The goal in treating asthma is to decrease the severity and frequency of symptoms by reducing inflammation. To help manage treatment, some healthcare providers may recommend using a peak flow meter. This handheld device can be used to help measure how the air travels from the lungs. Additionally, there are several asthma medications that can control asthma symptoms.

Asthma medications

Many fast-acting medications are available to make breathing easier. They act by reducing swelling and inflammation in the airways. These are commonly referred to as rescue inhalers because they work within minutes of taking them. Key treatments may include: 

Short-acting bronchodilators: Quick-relief medications, called bronchodilators, are used at the onset of symptoms during an asthma attack and work quickly to relax the airways and make breathing easier. The medication albuterol is often referred to as a rescue inhaler and works within minutes of use.

Long-acting bronchodilators:

Long-term control medications, taken daily, may be used to prevent and decrease the severity of asthma attacks.

Inhaled corticosteroids: Inhaled corticosteroids prevent inflammation.

Leukotriene modifiers: Leukotriene modifiers work by blocking leukotrienes, immune system chemicals that cause the airways to restrict in response to allergy triggers. 

Combination inhalers: Combination inhalers contain a corticosteroid to prevent inflammation and a bronchodilator to make breathing easier by relaxing the lungs and widening the airways.

Nebulization solutions: Like COPD, nebulization solutions can also be used for asthma treatment.

Oral steroids: These may be prescribed for one to two weeks following an attack to keep inflammation down. 

Other medications: 

Other asthma treatments

  • Avoiding allergens and irritants in the environment minimizes the effects of exposure. Nasal sprays are not approved for the treatment of asthma; however, they are effective in treating seasonal allergies that may trigger asthma.
  • Staying up to date on immunizations is also important in managing asthma because it helps keep the immune system strong and decreases the risk of a respiratory infection, which can exacerbate symptoms.
  • Non-steroidal injections of anti-IgE and anti-IL5 monoclonal antibodies may be used every two to eight weeks to reduce inflammation in people with severe, difficult-to-control asthma. These antibodies work by blocking specific molecular pathways in people with allergic asthma. These include Xolair (omalizumab) and Nucala (mepolizumab).
  • Bronchial thermoplasty, a procedure in which a bronchoscope is used to apply heat to the bronchial tubes, reducing the amount of smooth muscle present, can also be effective in treating severe asthma.
COPD vs. asthma treatments
COPD Asthma
  • Inhaled corticosteroids
  • Bronchodilators
  • Combination Inhalers
  • Antibiotics (for acute infections)
  • Oral steroids
  • Staying up to date on immunizations
  • Controlling exposure to environmental triggers
  • Healthy lifestyle changes
  • Phosphodiesterase-4 inhibitors
  • Theophylline
  • Smoking cessation
  • Pulmonary rehabilitation
  • Supplemental oxygen
  • Inhaled corticosteroids
  • Bronchodilators
  • Combination inhalers
  • Antibiotics (for acute infections)
  • Oral steroids
  • Staying up to date on immunizations
  • Controlling exposure to environmental triggers
  • Healthy lifestyle changes
  • Leukotriene modifiers
  • Monoclonal antibodies
  • Bronchial thermoplasty

Risk factors

COPD

Tobacco smoke is by far the most significant risk factor in developing COPD, whether a person is a smoker or has been exposed to long-term secondhand smoke. People with asthma are at increased risk of COPD, especially if they are smokers (secondhand smoke may also lead to COPD in asthmatics), and a work environment where exposure to dust, chemicals, or fumes increases risk. Alpha-1 antitrypsin deficiency, a genetic disorder that results in damage to the lung tissue, may also lead to COPD.

Asthma

Asthma is a lung disease that runs in families. According to the American Lung Association, a person whose parent has asthma is three to six times more likely to develop it during their lifetime than a person who does not have a family history of asthma. Childhood respiratory infections that damage the lungs, allergies, occupational exposure to irritants, smoking, and air pollution all increase a person’s odds of asthma. Obesity is linked to an increased risk of asthma.

COPD vs. asthma risk factors
COPD Asthma
  • Smoking
  • Exposure to secondhand smoke
  • Exposure to air pollution
  • Occupational exposure to dust, fumes, or chemicals
  • Childhood respiratory infections
  • Alpha-1 deficiency
  • Smoking
  • Exposure to secondhand smoke
  • Exposure to air pollution
  • Occupational exposure to dust, fumes, or chemicals
  • Childhood respiratory infections
  • Allergies
  • Genetics
  • Obesity

Prevention

COPD

The most important way for a person to prevent COPD is to avoid smoking or to stop if they already smoke. Quitting is the most important way for COPD patients to avoid further deterioration of lung health and extend their lifespan. It’s also important to stay away from secondhand smoke and avoid irritants like chemicals, dust, and fumes. Staying as healthy as possible by getting recommended immunizations and avoiding respiratory infections are helpful in preventing the escalation of COPD in people who have it.

Asthma

Cigarette smoke is extremely harmful to those with asthma, who should also avoid exposure to secondhand smoke. Avoiding triggering allergens and chemical irritants is important in people with asthma, as is staying healthy and getting vaccinated for the flu and other standard immunizations. 

People with an asthma treatment plan should stick to it, taking their medications as prescribed; immunotherapy, or allergy shots, can also help minimize the risk of an attack.

The Global Initiative for Asthma is a great resource for asthma patients, providing proven ways to prevent or lessen the spread or complications of asthma. 

How to prevent COPD vs. asthma
COPD Asthma
  • Do not smoke, or stop smoking
  • Avoid exposure to secondhand smoke
  • Protection from exposure to irritants chemicals, dust, and fumes
  • Try to stay healthy and up-to-date on vaccinations
  • Do not smoke, or stop smoking
  • Avoid exposure to secondhand smoke
  • Protection from exposure to irritants chemicals, dust, and fumes
  • Try to stay healthy and up-to-date on vaccinations
  • Avoid allergens

When to see a doctor for COPD or asthma

When experiencing breathing symptoms, it’s important to consult with a healthcare provider to find out if it could be COPD or asthma. A doctor will conduct thorough testing to determine an accurate diagnosis as well as an individualized treatment plan to help manage respiratory diseases.

Frequently asked questions about COPD and asthma

What is the difference between asthma and COPD?

Asthma is a respiratory disease affecting the bronchial tubes, or airways, making them sensitive to allergens or irritants, both of which can bring on an asthma attack. During an asthma attack, it is hard to breathe, and wheezing, coughing, and chest tightness may occur. While COPD can also cause these symptoms, it’s more likely to experience a consistent cough with phlegm. 

Unlike asthma, COPD is a chronic condition caused by damage to the lungs over time, most often from smoking, and it is irreversible. With asthma, breathing returns to normal after an attack, but COPD symptoms are more regular. Usually, COPD develops in people after age 40 and becomes a chronic disease of lung function while asthma may develop in people of almost any age.

Which is worse: COPD or asthma? 

COPD is worse than asthma. With a well-designed treatment plan, asthma symptoms can be controlled sufficiently to return lung function to normal, or very close to normal, so the condition is generally considered reversible. Though COPD symptoms can be well-managed with various treatments, the respiratory disease is irreversible, so any damage impairing lung function that has occurred cannot be restored.

Can asthma turn into COPD?

Asthma doesn’t always lead to COPD, but it is a risk factor. Lung damage caused by poorly controlled asthma along with continual exposure to irritants like cigarette smoke or occupational chemicals and fumes is irreversible and can increase a person’s risk of developing the lung disease COPD. It is possible to have both asthma and COPD, a condition called Asthma-COPD overlap syndrome (ACOS).

Do asthma inhalers help COPD?

Some of the same inhalers used in the management of asthma are also effective in COPD treatment. Bronchodilators work fast to relax the airways and make breathing easier, and inhaled corticosteroids decrease inflammation.

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