Breath by Breath
Although COPD is often tied to cigarette smoking, that’s not always the case. In fact, long-standing asthma can change the structure of the airways and chest wall over time, leading to the limited air flow and persistent lung problems of COPD. Whether or not smoking has caused the problem, asthma and COPD overlap can complicate your life.
Many people go undiagnosed or misdiagnosed for years, which can lead to a lot of unnecessary suffering. Once you have an accurate asthma-COPD diagnosis, you can adjust your management and treatment plan to focus on both sets of symptoms – a move that will bring more relief and could even extend your life.
Comparing Asthma and COPD
Both asthma and COPD hamper your respiratory system, making breathing uncomfortable and at times, nearly impossible. Each poses a danger to your lung function, overall health and quality of life, but the two conditions differ in some important ways, and it’s important to know how to tell them apart:
Inflammation
Both asthma and COPD involve inflammation of the airways, but that inflammation comes in different ways. In the case of asthma, allergic triggers tend to inflame your airways, and the list of potential allergens is long. From dust to dander, asthmatics know to watch out for particles that will inflame their sensitive system.
In comparison, the inflammation of COPD is always present (to some extent) when chronic bronchitis is involved, but it isn’t always the most pronounced symptom. In fact, breathing discomfort is generally due to dead or paralyzed tissue, not inflamed muscles in the airways. COPD inflammation also doesn’t respond well to anti-inflammatory medications (which are prescribed for asthma symptoms).
Persistence
While both conditions are chronic, COPD symptoms are steadier than asthma symptoms. For instance, asthma symptoms or attacks can come on suddenly in the presence of a trigger, but COPD symptoms are always there: patients often wake with a congested chest and a productive cough, and though it may lighten during the course of the day, breathing problems never disappear completely.
Recovery
Ultimately, asthmatics can bounce back with the right treatment; the airways are still functional, elastic and responsive. That’s not to say that asthma attacks aren’t dangerous, but if you can deal with the issue quickly and completely, you stand a good chance of returning to a comfortable breathing pattern.
Unfortunately, COPD is not only a chronic condition, it’s also progressive. The damage to the lungs, airways and alveoli is permanent, and the uncomfortable consequences (like breathlessness, pain, mucus and fatigue) will tend to worsen as time goes on. To make matters worse, the more COPD exacerbations you experience, the more likely you are to land in the hospital and the higher your risk of death.
The good news is that COPD can be controlled, even slowed down. But since COPD and asthma affect your body in different ways – and respond to different treatments – an accurate, early diagnosis is vital. If you’ve been told you have one condition, but you suspect another may be at play, see your doctor right away about the possibility of asthma-COPD overlap syndrome (ACOS).
The Overlap Syndrome
Asthma can hit at any age, but since COPD typically comes later in life (after many years of exposure to irritants), ACOS generally affects older patients. Experts estimate that more than 50% of ACOS cases occur in people over age 80, and less than 10% occur before age 50.
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Spotting the Symptoms
Since asthma symptoms and COPD symptoms are already difficult to tell apart, it’s not easy to determine if there’s an overlap without allergy, breathing or sputum tests. However, there are a few warning signs that call for further investigation:
- Bronchial hyperresponsiveness (BHR): Sudden breathing difficulty caused by allergic triggers is a mainstay of asthma, but also present in overlap syndrome.
- More exacerbations: COPD exacerbations (which are usually sparked by viral or bacterial infection) can be up to three times more frequent and severe when ACOS is present than in COPD alone.
- Wheezing, cough and chest tightness: Both asthma and COPD bring chest discomfort, but when these symptoms worsen during the night or in the early morning, there’s a higher chance of ACOS.
If you have several warning signs of overlap syndrome — such as advanced age, history of smoking, longstanding asthma and more than four exacerbations a year — you need to consult with your doctor about testing for ACOS. If you are diagnosed with both asthma and COPD, you may need to adjust your treatment plan.
Managing Asthma and COPD Together
The first step to better breathing is quitting smoking. If you haven’t already done so, work with your doctor to create a plan of attack to quit for good – it will make a huge difference in the amount and severity of your symptoms.
There are some other ways to reduce your symptoms, too:
Try Pulmonary Rehabilitation
Pulmonary rehabilitation is a program of exercise, breathing techniques and education that is proven to help COPD patients improve their comfort and quality of life. Research also shows that asthmatics who have a history of anxiety or depression and persistent breathlessness can also benefit from pulmonary rehab, so it’s certainly worth your while if you suffer from both conditions.
Control Allergies
Allergens can set off asthma, and asthma symptoms can worsen your COPD symptoms. Stop the problem at the source by avoiding allergic triggers at all costs: stay away from smoke, irritating chemicals and allergens like dust and mold.
Relax your Airways
Inhaled corticosteroids are a first line of defense for asthma, but they won’t work nearly as well for COPD symptoms because the inflammation is coming from different sources (allergens versus tissue damage). However, long-acting bronchodilators can be exceptionally helpful for both asthma and COPD. Many doctors recommend using an inhaler that combines both medications to avoid flare-ups and improve breathing.
Since infection can lead to complications like exacerbations, it’s very important that you take good care to avoid illness and treat any problems as early as possible. Report any changes or suspicious symptoms to your doctor right away – if they can stop a lower respiratory tract infection before it progresses further, you have a much better chance of avoiding the emergency room.
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