Is It Asthma or COPD?
Differences between these lung conditions aren’t always clear-cut.
Coughing and shortness of breath are symptoms of both asthma and COPD.
By Lisa EspositoFeb. 18, 2015 | 9:44 a.m. EST+ More
When you develop a lung disease such as asthma or chronic obstructive pulmonary disease, it becomes a part of your life. The big question is: How can I breathe better? The first step is getting the diagnosis straight. Some asthma and COPD differences are subtle, and there’s even a third possibility: asthma-COPD overlap syndrome. Here's a look at how two affected people are coping with their circumstances.
Asthma: Starting Young
Mitchell Spanjers, 20, a college junior in Minnesota, found out he had asthma in kindergarten. “I live in a suburb with a decently sized backyard, and I was running around and it got hard to breathe,” he recalls. His pediatrician soon made the diagnosis.
He continued being an active kid. But he identifies one aspect of the condition as his “Achilles’ heel,” especially in elementary school: his inhaler. “I remember having to turn my back and take it,” Spanjers says. “I was just embarrassed.”
Then there was the spacer. Attached to the inhaler, it gets more medication into the lungs. “But spacers are so bulky and massive that I needed a whole extra pouch to carry that in,” Spanjers says. “If I’m a kid, playing with my friends … or I would go to a hockey rink, just carrying that around.”
In fourth grade, Spanjers had a scary episode. “I went to school with walking pneumonia, and I couldn’t breathe at all,” he says. For once, his inhaler provided no relief. By the time he got to the doctor’s office, his fingertips and mouth were blue from lack of oxygen. He had an ambulance ride to the hospital, where he stayed four days on steroid treatment.
That was his low point, Spanjers says. Ever since then, he feels like he got stronger and less bothered by asthma, although he says humid days with a high heat index “make it a bit harder.”
Asthma involves inflammation and narrowing of the airways. It has a strong allergic component, with individual triggers such as colds, exercise, seasonal changes, pollen, household mold, smoke and weather extremes provoking flare-ups.
“Ninety to 100 percent of children with asthma have a coexisting environmental allergy,” says Michael Foggs, immediate past president of the American College of Allergy, Asthma and Immunology, and an allergist-immunologist in Chicago.
Asthma has no known cause. Risk factors include having a relative with asthma, being overweight and smoking or exposure to secondhand smoke. Symptoms include night coughing, shortness of breath, wheezing and chest tightness, pain or pressure.
Adult-onset asthma only constitutes a “fraction” of the total cases, Foggs says. “Asthma is largely a childhood disease that continues into adult life.”
COPD: Midlife Shock
For Thelma Cribbs, life took a sudden, sharp downturn. At 50, she had been living in Georgia, juggling two jobs and walking 10 miles a day. Her health was “excellent.”
But then she started getting breathless just walking through her house, “All of a sudden, it was just there. It was really bad,” Cribbs says. “I was hanging my head, trying to catch my breath; trying to figure out what was going on. Wiping my face with a washcloth.”
Cribbs learned she had emphysema, one of the lung conditions included in COPD. Now disabled, she’s living in Utica, New York, with a relative.
“It hurts to try and draw a breath,” Cribbs says. She uses three inhalers and a nebulizer and has just started on oxygen therapy. And at 56, she’s become a virtual shut-in. “I only leave my house now to go to the doctor,” she says. “I only leave my bedroom to go to the bathroom.”
That’s not uncommon, says Jim Nelson, a COPD Foundation volunteer who underwent a double lung transplant in 2011. “There’s a real tendency that we fight all the time – people who are on oxygen, who are wearing a cannula – to hide.”
But many people with COPD on oxygen manage airline travel and myriad activities by planning ahead and pacing themselves.
COPD is a catchall term for bronchitis, emphysema and in some cases, chronic asthma. Airflow obstruction is the common denominator. Patients have coughing, thick mucus or phlegm, and most of all, shortness of breath. Symptoms are continual and progressive.
COPD is an adult disease, usually diagnosed in middle or older age. Smoking is the direct cause of COPD for 85 to 90 percent of people with the condition in most Western nations, Foggs says.
In a minority of cases, a genetic condition called alpha-1 antitrypsin deficiency is the cause. And for other patients, environmental and occupational exposures are culprits.
In her case, Cribbs says, a chemical was to blame. She attributes her COPD to formaldehyde exposure many years ago, when she and her ex-husband worked on a ranch and used the chemical to preserve cattle feed. “I would breathe in the formaldehyde, and it damaged my lungs,” she says. She had quit smoking when she was 16.
“Formaldehyde has been formally linked to the development of COPD in the medical literature,” Foggs says. However, he adds, multiple factors could contribute in such a case, even in a nonsmoker.
Sorting Out Conditions
An estimated 15 million adults in the United States have COPD, according to the Centers for Disease Control and Prevention. Meanwhile, asthma affects nearly 19 million adults and 7 million children.
“Clearly, COPD is the more deadly and ominous disease, by virtue of the fact that less than 3,500 people per year in the U.S. die from asthma,” Foggs says. “Over 130,000 people per year in the U.S. die from COPD.”
To get an accurate diagnosis with respiratory conditions, it’s crucial for anyone age 5 or older to have their lung function tested with spirometry, Foggs says. The test involves breathing into a small apparatus, the spirometer, to determine how much air you inhale and exhale, and how quickly. Other evaluations may be needed to confirm the diagnosis and stage of the disease.
For smokers, helping them quit is "the No. 1 most important intervention that can be made in the person with COPD," Foggs says. And, of course, it's important for asthma patients, too.
In terms of medication, some treatments for COPD would be inappropriate for asthma patents and vice versa.
“All the medicines that are used to treat asthma, with the exceptions of leukotriene modifiers, are used to treat COPD,” Foggs says. Leukotriene modifiers include Accolate, Singulair and Zyflo.
But other drugs, such as Spiriva and Anoro Ellipta, are only approved for COPD.
Cribbs struggles to afford her medicine. “Insurance doesn’t cover any of my inhalers,” she says, nor the full cost of oxygen therapy. Medication coupons and samples provided by her doctor help her get by, but sometimes, she says, she just does without.
“I never, in a million years, thought my life would be like this,” Cribbs says. “Never.” She recently reached out to the COPD Foundation for support in locating resources.
Spanjers, whose college major is entrepreneurship, has taken on a new project: making a more kid-friendly inhaler. He and his project partner are seeking input from parents and pediatricians, and are coming up with design ideas to make life a bit easier for kids with asthma.