This post was written by Eileen Muzzillo, MD, PPG – Internal Medicine.
According to recent data, chronic obstructive pulmonary disease (COPD) affects about 300 million people worldwide, adding up to approximately 64 million disability-adjusted life years. The American Lung Association reported that in 2020, there were more than 335,000 COPD hospitalizations. Compare these numbers to those of asthma. In 2018, 41.9 million Americans, or 13%, had been diagnosed with asthma by a healthcare professional, which is an increase of 43% from 9.1% in 1999. The significant prevalence of COPD and asthma motivates providers to stay vigilant in recognizing the signs and symptoms to initiate appropriate treatment.
Defining the diagnoses
The 2024 Global Initiative for Asthma (GINA) Report defined asthma as “a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms, such as wheeze, shortness of breath, chest tightness and cough, that vary over time and in intensity, together with variable expiratory airflow limitation.”
The 2023/2024 GOLD Report, defined COPD as a “heterogenous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production and/or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction.”
Symptoms
Asthma often presents with respiratory symptoms of:
- wheezing
- shortness of breath
- cough
- chest tightness
These symptoms can sometimes worsen at night or early morning and vary over time and in intensity. They can be triggered by viral infections (colds), exercise, allergen exposure, changes in weather, laughter or irritants such as car exhaust fumes, smoke or strong smells. (Read more here.)
COPD can present with respiratory symptoms of:
- progressive or exertional dyspnea
- a productive or nonproductive cough
These symptoms are linked to risk factors such as:
- tobacco smoke
- occupational dust, vapor, fumes, gases, or other chemicals
- developmental abnormalities
- recurrent childhood respiratory infections
Surprisingly, an estimated 25-45% of patients with COPD worldwide have never smoked.
Diagnosis and treatment
These two chronic conditions have several similarities in symptom presentation, so, just like with any chronic condition, reaching the correct diagnosis is a key step to prevent over- or undertreatment. Spirometry–a breathing test to assess different lung volumes upon inhalation and exhalation–is the most useful tool for deducing the correct diagnosis between asthma and COPD. (Read more here.)
For asthma, the focus is assessing forced expiratory volume in 1 second (FEV1) and the ratio of FEV1 to forced vital capacity (FEV1/FVC) with the responsiveness of lung volume changes to a bronchodilator. Once these values are obtained and interpreted, patients can be guided to the appropriate treatment. (Read more here.)
However, the patient’s journey does not stop there. Regular visits with the patient’s primary care provider or specialist will need to occur to reassess and discuss the improvement of symptoms with the treatment regimen. This is especially true if a patient has had a recent hospitalization due to an exacerbation from asthma or COPD. A post-hospital visit is critical in preventing future unnecessary exacerbations or hospitalizations.
If you or a loved one have concerns about your breathing or risk factors that could lead to asthma or COPD, talk to your primary care provider. The PPG – Allergy, Asthma & Immunology team can also offer excellent care should you need assistance managing an asthma diagnosis.
