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How are COPD and Asthma Related?

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People familiar with Chronic Obstructive Pulmonary Disease (COPD) and asthma understand that both conditions have essential commonalities and very significant differences. Although both cause swelling of the airways, each one has varying causes, risk factors, and triggers. Knowing how they overlap and understanding key symptoms can help your loved one stay healthy. 


What is COPD?

COPD is a chronic inflammatory airway disease that causes obstructed airflow. The cause is most often from consistent long-term exposure to irritants or particulates in the air, like smoking or second-hand smoke. Damage to fragile airway walls, injury to alveoli, or inflammation and narrowing of bronchial tubes can all contribute to COPD.


COPD Symptoms 

Unfortunately, COPD symptoms don't manifest themselves until there has already been significant lung damage. Although COPD is a progressive disease that worsens over time, it can be treated and slowed as long as it’s diagnosed in time. 


The most common signs and symptoms of COPD are: 

  • A chronic cough
  • Clear, white, yellow, or greenish sputum or phlegm
  • Wheezing
  • Chest tightness
  • Fatigue
  • Shortness of breath, particularly with during physical exertion
  • Repeated respiratory infections
  • Weight loss is late stages of COPD
  • Swelling in lower limbs and feet


People who have COPD typically experience exacerbations and flare-ups. During these episodes, their symptoms become worse for several days or more.


What is Asthma? 

Most people consider asthma to be a childhood disease. Because of this, asthma is often underdiagnosed in older adults. What is worrisome, however, is that asthma in the elderly also has higher morbidity and mortality rates when compared to younger people with asthma. 

Asthma is an airway inflammation condition where airways become narrow, inflamed, and may have excessive mucus. The narrowing of the airways causes a distinct whistling sound called wheezing as the person breathes out. Individuals with asthma may also experience shortness of breath and reduced lung health. 


Asthma Symptoms

In older adults, asthma may pose a significant problem, making daily activities challenging, and leading small triggers to cause asthma attacks. Because the lungs of older adults are weaker, asthma attacks are difficult to tolerate and can be life-threatening. Therefore, appropriately diagnosing and treating asthma is exceptionally vital for older adults.


The most common features of asthma are:

  • Coughing or wheezing
  • Shortness of breath
  • Chest tightness or pain
  • Trouble sleeping due to wheezing or shortness of breath

People with asthma typically see a worsening of symptoms when they have a respiratory infection, such as a flu or cold. People living with asthma may also experience triggers that make their asthma worse, like smoke or air pollution. 


Differences and Similarities Between COPD and Asthma 

Because COPD and asthma have so many similarities, it’s challenging to determine which condition a person may have. In older adults, distinguishing between the two is all the more difficult due to the presence of other health problems. Determining whether an older adult has COPD or asthma may require a physician or other healthcare provider to assess the clinical features through a physical exam, obtain chest x-rays, and make an accurate diagnosis. 


Similarities Between COPD and Asthma


  • Both are lung diseases
  • Both cause swelling within the airways
  • Both cause shortness of breath
  • Both may cause chest tightening
  • Both show family history as a risk factor


Differences Between COPD and Asthma

  • A diagnosis of asthma typically occurs in a person’s younger years
  • A diagnosis of COPD usually happens when a person is an older adult
  • Asthma is triggered by allergens like tobacco smoke, irritants in the environment or physical activity
  • Risk factors for COPD are smoking or long-term exposure to pollutants or lung irritants
  • Emphysema and chronic bronchitis are usually a cause of airflow obstruction, leading to COPD
  • COPD is constant and worsens over time
  • Asthma typically improves over time (in younger people)

Despite their differences, COPD and asthma can exist at the same time — particularly in older adults.


Do COPD and Asthma Overlap?

Older adults may have COPD and asthma at the same time, and the condition is called Asthma-COPD overlap syndrome (ACOS or ACO). Although ACO is not a separate disease, the diagnosis identifies a person as having both COPD and asthma.


Adults who have asthma as children have a higher risk of developing COPD later in life. The belief is that persistent childhood asthma may affect a child’s developing lungs and this places them at a higher risk for COPD as adults. The prevalence of asthma-COPD overlap is roughly 25% of people with COPD and about 20% of people with asthma. 


Older Adults with COPD and Asthma

Older adults who have both COPD and asthma, however, have more symptoms than they would with asthma or COPD alone. Therefore, adults who have both need extra attention and care to overcome the shortness of breath and fatigue that comes with ACO and other comorbidities. For example, older adults with ACO show clinical symptoms that impact their overall quality of life. These symptoms include:

  • Dyspnea
  • Reduced lung function
  • Severe exercise intolerance

Because older adults have little room for a decline, it’s essential to maintain their lung function and activity tolerance to counter the effects of ACO. Furthermore, older adults tend to have multiple other diagnoses that may influence COPD and asthma. Maintaining routine physical exams, good communication with primary care professionals, and adhering to treatment plans are vital for care, especially because older adults have multiple medications and comorbidities. 


Treatments for COPD or Asthma

Older adults require close monitoring by a healthcare professional for COPD or asthma. Typical Medications for COPD, asthma, or ACO are typically bronchodilators and may consist the following: 

  • Beta2 Agonists 
  • Anticholinergics 
  • Antibiotics
  • Inhaled Corticosteroids
  • A combination of two or more of the above

The management of asthma and COPD in older individuals may require a different approach, as some older adults may have difficulty with asthma treatments that are typically used on younger people. For example, they may lack the dexterity needed to utilize L-shaped metered dose inhalers, therefore treatments with dry powder-type inhalers or medication may be preferable.


Symptom Management for Older Adults 

  • Breathing exercises offer a good way for older adults to maintain lung capacity and overcome airflow limitations 
    • Techniques like diaphragmatic breathing, pursed-lip breathing, and nasal breathing can alleviate symptoms.
  • Aerobic exercises, if approved by a physician, also help to improve endurance and activity tolerance.
    • A physician may choose to prescribe home-bound breathing equipment to assist with breathing or boost sleep quality.
  • Nebulizers also offer older adults an easier way to open their airways.
  • Pulmonary rehabilitation, under the supervision of a specialist, provides a treatment plan to rebuild and maintain lung function.
  • Lastly, one of the most significant treatments a person with COPD or asthma can do is to stop smoking. 


Caring for Your Loved One with COPD or Asthma

Caregivers should be aware that:

  • Seniors may not report their symptoms, even when those symptoms are dangerous. 
  • Older adults may not have the cognitive ability to recognize their symptoms.
  • Some seniors may deny their diagnosis and their health status.
  • Older adults may ignore their symptoms, even if they interfere with their daily activities.

Unfortunately, seniors may think their breathing issues are typical and may be hesitant to seek medical assistance. They may be unaware that their condition affects their ability to care for themselves or remain healthy. 

Spotting COPD or asthma and obtaining an accurate diagnosis are the first steps to treating these breathing conditions. With some attention and medical care, seniors with COPD or asthma can maintain their quality of life.



Maria Morioka

A Licensed Registered Nurse in the mental health field with nearly 15 years of experience. 

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