Dr. Srivatsa Lokeshwaran, Lead Consultant and Head of Department – Interventional Pulmonology and Lung Transplant, Aster Whitefield Hospital, Bengaluru

Breathing should be effortless. But for millions, conditions like asthma and COPD (Chronic Obstructive Pulmonary Disease) make every breath feel like a struggle. While both involve difficulty breathing and narrowed airways, asthma and COPD are not the same condition. They differ in causes, age of onset, triggers, progression, and treatment approaches.

Confusing the two can delay the right care. Some people with long-standing asthma may even be misdiagnosed with COPD, or vice versa. So, how do you tell them apart? Whether you’re a patient or caregiver, here are 7 key differences between asthma and COPD you should know.

1. Age of Onset

• Asthma typically begins in childhood or early adulthood, although adult-onset asthma does exist.
• COPD is usually diagnosed in people over 40, especially those with a long history of smoking or exposure to pollutants.

2. Causes

• Asthma is often linked to genetics, allergies, or environmental triggers like dust mites, pollen, or cold air. It’s considered an inflammatory response of the airways.
• COPD is mainly caused by long-term exposure to irritants—most commonly smoking, but also air pollution or occupational fumes.

3. Symptoms Pattern

• Asthma symptoms (wheezing, breathlessness, chest tightness, coughing) often come and go—flaring up with triggers, and improving with treatment or spontaneously.
• COPD symptoms are persistent and progressive, with a slow worsening over time. The cough (often with phlegm) may become chronic.

4. Lung Function Reversibility

• Asthma is reversible. Lung function often returns to normal between attacks or improves significantly with inhalers.
• In COPD, the airflow limitation is irreversible or only partially reversible, even with medication.

5. Response to Medication

• Asthma responds very well to bronchodilators and inhaled steroids.
• COPD patients may need a combination of long-acting bronchodilators, steroids, oxygen therapy, and lifestyle changes, but their response is typically less dramatic.

6. Triggers

• Asthma flares are often triggered by allergens, exercise, cold air, or stress.
• COPD flares (also known as exacerbations) are more likely caused by respiratory infections, ongoing smoking, or worsening air quality.

7. Progression

• Asthma, with proper management, can remain stable and well-controlled for years—even go into remission.
• COPD is a progressive disease, meaning it tends to get worse over time, and may eventually limit daily activities and quality of life.

Knowing whether you have asthma or COPD isn’t just a technical detail—it shapes your entire treatment plan. For instance, asthma requires a focus on inflammation control and avoiding allergens, while COPD care revolves around lung preservation, smoking cessation, and managing long-term symptoms.

Sometimes, people—especially older adults—can have features of both conditions. This is called Asthma-COPD Overlap Syndrome (ACOS), and it requires a more tailored approach. If you or a loved one experience frequent breathlessness, chronic cough, or wheezing, don’t ignore it. A lung function test (spirometry) and a good clinical history can help doctors pinpoint the cause—and get you on the right treatment path.