Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentOverlap Syndrome
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Overlap Syndrome
Asthmaandchronic obstructive pulmonary disease (COPD)are both respiratory diseases involving chronic inflammation that leads to airflow obstruction. While they share similar symptoms, their causes and treatments differ. In some cases, asthma and COPD may overlap in what is termed asthma-COPD overlap syndrome, or ACOS.
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Both asthma and COPD may present with these symptoms:
However, the frequency and predominating symptoms in asthma and COPD are different. With COPD, you are more likely to experience a morning cough, increased amounts of sputum, and persistent symptoms. If you have asthma, you are more likely to experience episodic symptoms during and/or at night.
Another difference between asthma and COPD is the intermittent symptoms seen with asthma versus the chronic, progressive symptoms seen in COPD. Asthma symptoms are likely to occur after exposure to specific triggers, whereas COPD symptoms occur more regularly.
1:467 Differences Between COPD and Asthma
1:46
7 Differences Between COPD and Asthma
There are a number of other differences between COPD and asthma as well.
Often diagnosed during childhood or adolescence
Symptoms more likely to occur episodically and/or at night
People who have asthma are more commonly nonsmokers
Comorbid conditions include eczema and allergic rhinitis
Treatment usually involves inhaled steroids
Airflow obstruction mostly reversible
Often diagnosed during adulthood
Likely to cause morning cough, increased sputum, and persistent symptoms
Most people who have COPD have smoked or had significant secondhand smoke exposure
Comorbid conditions include coronary heart disease or osteoporosis
Treatment usually involves pulmonary rehabilitation
Airflow obstruction is permanent or only partially reversible
Once you develop COPD, your symptoms will generally be chronic. Over time, with COPD, you are likely to experience symptoms that are not typical for asthma—losing weight, decreased strength, and diminished endurance, functional capacity, and quality of life.
Both asthma and COPD may be considered inflammatory diseases, but the inflammation comes from different types of white blood cells.
Both conditions are diagnosed via a combination of your history, a physical exam, and diagnostic testing.
They will do a physical examination, listening for signs of wheezing, shortness of breath, and cough. They may also look for signs of nasal inflammation that can make asthma symptoms more pronounced.
Diagnostic Tests
Spirometryis a simple, non-invasive breathing test that is often used in the assessment of COPD and asthma.Spirometry is usually performed in a practitioner’s office. Your healthcare provider will instruct you on how to breathe into a small device while measuring certain aspects of your lung function such as forced expiratory volume (FEV1), which is the amount of air that can be forcefully exerted from the lungs in one second.
If your healthcare provider thinks you might have COPD, they will also measure your blood oxygen level via non-invasivepulse oximetryand/or anarterial blood gases (ABG)blood test.
Your practitioner may also request that you undergoimagingsuch as an X-ray or computed tomography (CT) scan, which can identify abnormalities in the lungs and potentially rule out other conditions.
Asthma and COPD are treated with different treatments because the cause of inflammation is different. The goals of treatment in asthma and COPD are also different.
Airflow Obstruction: Reversible or Permanent?Asthma treatment generally returns lung function to normal or near-normal and you should not have many asthma symptoms between asthma exacerbations. Airflow obstruction in asthma is generally considered reversible, though some people who have severe asthma develop irreversible damage.Even with COPD treatment, airflow obstruction and lung function will likely not return to normal or may only partially improve—even with smoking cessation and bronchodilator usage.
Airflow Obstruction: Reversible or Permanent?
Asthma treatment generally returns lung function to normal or near-normal and you should not have many asthma symptoms between asthma exacerbations. Airflow obstruction in asthma is generally considered reversible, though some people who have severe asthma develop irreversible damage.Even with COPD treatment, airflow obstruction and lung function will likely not return to normal or may only partially improve—even with smoking cessation and bronchodilator usage.
Medications
Some of the same medications are used for the treatment of asthma and COPD, but the “when, why, and how” of these medications may be different. Medications used for the treatment of asthma and COPD may include inhaled steroids, anticholinergics, short-acting bronchodilators (SABAs), and long-acting beta-agonists (LABAs).
Inhaled Steroids
Inhaled steroidsare advantageous in both asthma and COPD because the medication acts directly in the lung. However, inhaled steroids are used differently in asthma and COPD.
Anticholinergics
Short-acting anticholinergics, such as Atrovent, are used in the treatment of acute asthma exacerbations, while long-acting anticholinergic Spiriva is prescribed as a controller medication in asthma.
Spiriva is used relatively early in COPD because it has been associated with improvements in lung function, symptoms, and quality of life while decreasing COPD exacerbations and hospitalizations.
Short-Acting Bronchodilators (SABAs)
In asthma,SABAsare used for the periodic relief of acute symptoms. The need for using a SABA frequently may mean that you have met the criteria for mild persistent asthma—and additional medication will be required.
In contrast, scheduled SABAs are among the first treatments used for COPD.
Long-Acting Beta-Agonists (LABAs)
WhileLABAslike Serevent may be used for early COPD treatment, these drugs are indicated for the treatment of moderate persistent asthma, not for mild asthma.
Bronchial Thermoplasty
This intervention is used for the treatment of severe persistent asthma that is not well-controlled with inhaled corticosteroids and LABAs. Abronchoscopyis used to apply heat to the airways to decrease their ability to constrict (narrow), such as when exposed to triggers that can lead to an asthma attack.
Surgery
Surgical treatment is not used to manage asthma, and it can be a treatment option in rare cases of COPD. This treatment is generally reserved for people who have has severe lung damage despite medical therapy.
Lung volume reduction surgery (LVRS) can be done to remove severely damaged lung tissue (up to 30% of lung volume) so that the remaining lung tissue can function more efficiently.LVRS is performed with video assistance and is a minimally invasive procedure, although the surgery is significant.
While asthma and COPD are two separate conditions, some people have features of both conditions and may be diagnosed with overlap syndrome, also known asasthma-chronic obstructive pulmonary disease (ACOS).
Studies have shown that between 10 to 20% of people who have COPD also have asthma. Surprisingly, 1 in 4 people with asthma smoke, and are at risk for COPD like any other smoker.
ACOS causes frequent exacerbations, worse quality of life, and more comorbidities (other diseases or conditions occurring at the same time) than asthma or COPD alone.
Treatment for ACOS primarily consists of symptom management and depends on which condition is more predominant. Medications such as low-dose corticosteroids, LABAs, and long-acting muscarinic agonists may be used along with lifestyle changes.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Lung Association.Asthma-COPD Overlap Syndrome.American Academy of Allergy Asthma and Immunotherapy.Asthma vs COPD.American Academy of Family Physicians.COPD and Asthma Differential Diagnosis.Lee Y, Quoc QL, Park HS.Biomarkers for severe asthma: Lessons from longitudinal cohort studies.Allergy Asthma Immunol Res.2021 May;13(3):375-389. doi:10.4168/aair.2021.13.3.375Lei S, Li M, Duan W, Peng C, Chen P, Wu S.The long-term outcomes of tobacco control strategies based on the cognitive intervention for smoking cessation in COPD patients.Respir Med. 2020 Oct;172:106155. doi:10.1016/j.rmed.2020.106155Dombret MC, Alagha K, Boulet LP, et al.Bronchial thermoplasty: a new therapeutic option for the treatment of severe, uncontrolled asthma in adults.Eur Respir Rev.2014;23(134):510-8. doi:10.1183/09059180.00005114Columbia University Surgery.Surgical Lung and Chest Care: Lung Volume Reduction Surgery.Barnes PJ.Asthma-COPD overlap. Chest. 2016 Jan 1;149(1):7-8. doi:10.1016/j.chest.2015.08.017Hines KL, Peebles RS.Management of the asthma-COPD overlap syndrome (ACOS): a review of the evidence.Current Allergy and Asthma Reports. 2017 Mar 1;17(3):15. doi:10.1007/s11882-017-0683-4Additional ReadingGibson PG, Mcdonald VM.Asthma-COPD overlap 2015: Now we are six.Thorax. 2015;70(7):683-91. doi:10.1136/thoraxjnl-2014-206740Postma DS, Rabe KF.The Asthma-COPD overlap syndrome.N Engl J Med. 2015;373(13):1241-9. doi:10.1056/NEJMra1411863
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Lung Association.Asthma-COPD Overlap Syndrome.American Academy of Allergy Asthma and Immunotherapy.Asthma vs COPD.American Academy of Family Physicians.COPD and Asthma Differential Diagnosis.Lee Y, Quoc QL, Park HS.Biomarkers for severe asthma: Lessons from longitudinal cohort studies.Allergy Asthma Immunol Res.2021 May;13(3):375-389. doi:10.4168/aair.2021.13.3.375Lei S, Li M, Duan W, Peng C, Chen P, Wu S.The long-term outcomes of tobacco control strategies based on the cognitive intervention for smoking cessation in COPD patients.Respir Med. 2020 Oct;172:106155. doi:10.1016/j.rmed.2020.106155Dombret MC, Alagha K, Boulet LP, et al.Bronchial thermoplasty: a new therapeutic option for the treatment of severe, uncontrolled asthma in adults.Eur Respir Rev.2014;23(134):510-8. doi:10.1183/09059180.00005114Columbia University Surgery.Surgical Lung and Chest Care: Lung Volume Reduction Surgery.Barnes PJ.Asthma-COPD overlap. Chest. 2016 Jan 1;149(1):7-8. doi:10.1016/j.chest.2015.08.017Hines KL, Peebles RS.Management of the asthma-COPD overlap syndrome (ACOS): a review of the evidence.Current Allergy and Asthma Reports. 2017 Mar 1;17(3):15. doi:10.1007/s11882-017-0683-4Additional ReadingGibson PG, Mcdonald VM.Asthma-COPD overlap 2015: Now we are six.Thorax. 2015;70(7):683-91. doi:10.1136/thoraxjnl-2014-206740Postma DS, Rabe KF.The Asthma-COPD overlap syndrome.N Engl J Med. 2015;373(13):1241-9. doi:10.1056/NEJMra1411863
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Lung Association.Asthma-COPD Overlap Syndrome.American Academy of Allergy Asthma and Immunotherapy.Asthma vs COPD.American Academy of Family Physicians.COPD and Asthma Differential Diagnosis.Lee Y, Quoc QL, Park HS.Biomarkers for severe asthma: Lessons from longitudinal cohort studies.Allergy Asthma Immunol Res.2021 May;13(3):375-389. doi:10.4168/aair.2021.13.3.375Lei S, Li M, Duan W, Peng C, Chen P, Wu S.The long-term outcomes of tobacco control strategies based on the cognitive intervention for smoking cessation in COPD patients.Respir Med. 2020 Oct;172:106155. doi:10.1016/j.rmed.2020.106155Dombret MC, Alagha K, Boulet LP, et al.Bronchial thermoplasty: a new therapeutic option for the treatment of severe, uncontrolled asthma in adults.Eur Respir Rev.2014;23(134):510-8. doi:10.1183/09059180.00005114Columbia University Surgery.Surgical Lung and Chest Care: Lung Volume Reduction Surgery.Barnes PJ.Asthma-COPD overlap. Chest. 2016 Jan 1;149(1):7-8. doi:10.1016/j.chest.2015.08.017Hines KL, Peebles RS.Management of the asthma-COPD overlap syndrome (ACOS): a review of the evidence.Current Allergy and Asthma Reports. 2017 Mar 1;17(3):15. doi:10.1007/s11882-017-0683-4
American Lung Association.Asthma-COPD Overlap Syndrome.
American Academy of Allergy Asthma and Immunotherapy.Asthma vs COPD.
American Academy of Family Physicians.COPD and Asthma Differential Diagnosis.
Lee Y, Quoc QL, Park HS.Biomarkers for severe asthma: Lessons from longitudinal cohort studies.Allergy Asthma Immunol Res.2021 May;13(3):375-389. doi:10.4168/aair.2021.13.3.375
Lei S, Li M, Duan W, Peng C, Chen P, Wu S.The long-term outcomes of tobacco control strategies based on the cognitive intervention for smoking cessation in COPD patients.Respir Med. 2020 Oct;172:106155. doi:10.1016/j.rmed.2020.106155
Dombret MC, Alagha K, Boulet LP, et al.Bronchial thermoplasty: a new therapeutic option for the treatment of severe, uncontrolled asthma in adults.Eur Respir Rev.2014;23(134):510-8. doi:10.1183/09059180.00005114
Columbia University Surgery.Surgical Lung and Chest Care: Lung Volume Reduction Surgery.
Barnes PJ.Asthma-COPD overlap. Chest. 2016 Jan 1;149(1):7-8. doi:10.1016/j.chest.2015.08.017
Hines KL, Peebles RS.Management of the asthma-COPD overlap syndrome (ACOS): a review of the evidence.Current Allergy and Asthma Reports. 2017 Mar 1;17(3):15. doi:10.1007/s11882-017-0683-4
Gibson PG, Mcdonald VM.Asthma-COPD overlap 2015: Now we are six.Thorax. 2015;70(7):683-91. doi:10.1136/thoraxjnl-2014-206740Postma DS, Rabe KF.The Asthma-COPD overlap syndrome.N Engl J Med. 2015;373(13):1241-9. doi:10.1056/NEJMra1411863
Gibson PG, Mcdonald VM.Asthma-COPD overlap 2015: Now we are six.Thorax. 2015;70(7):683-91. doi:10.1136/thoraxjnl-2014-206740
Postma DS, Rabe KF.The Asthma-COPD overlap syndrome.N Engl J Med. 2015;373(13):1241-9. doi:10.1056/NEJMra1411863
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