Asthma vs COPD

[Frankie4Sanity]

I was diagnosed with Severe Asthma this year and whilst COPD was mentioned, it was not diagnosed. I have been a smoker for over 30 years and have been through the NHS stop smoking system and now just have a single cigarette a day (GP still not happy!) My Asthma is not under control yet and yesterday the GP increased the use of my inhaler from 1 puff morning and evening to 2 puffs morning, 2 puffs lunch time and 2 puffs evening. I don't understand how they differentiate between Asthma and COPD and would welcome some clarification if anyone can help to stop my worries that I may have been mis-diagnosed.

[Mopsey1897]

I think asthma is triggered by pollutants such as perfume, smoke etc whereas copd symptoms are there all the time but get worse on exertion. I may be wrong though asthma means you don’t breathe in enough, copd you can’t breath out enough ?

[B0xermad in reply to Mopsey1897]

I have both asthma bronchiectasis and copd but triggers are mainly the asthma ,clogged lungs with bronchiectasis required clearance and copd(emphysema) Is breathlessness on exertion for me

[NieceByMarriage]

I have recently gone into all of this with a lung consultant. Asthma and COPD are both obstructive conditions (I have both). This means you have a problem breathing out rather than a problem breathing in, although in practice it is impossible to tell from physical feelings. Asthma tends to have particular triggers (could be smoke, pollen, perfume, exercise) but can be present all the time without many obvious triggers (like mine). The big diagnostic difference is via spirometry. If your spirometry results are significantly or fully relieved with a bronchodilator then the diagnosis is asthma. If they are not at all relieved then you have COPD. I have both which means my results were significantly relieved by bronchodilator BUT even after it my FEV1/FVC reading remained less than 70% of predicted.

It matters because asthma treatment these days has an element of inhaled steroids. Long term inhaled steroids carry a higher risk of pneumonia being worse than it might otherwise be. The risk/reward ratio is usually worth it for asthma but not necessarily worth it for COPD. So if you have COPD and not asthma you might want to think carefully about whether inhaled steroids are worth it in your case.

Given your smoking history and the habit of medics to jump on a COPD diagnosis for that and ignore everything else I think it is quite possible that you do actually have asthma even if you also have COPD. My lung consultant also said that if people have both conditions they quite often only diagnose asthma because this makes sure you keep the steroid element of treatment which otherwise may be forgotten about on medication reviews if they see COPD staring out from your notes.

Hope this helps.

[Frankie4Sanity in reply to NieceByMarriage]

That's really helpful, thank you so much

[Mopsey1897 in reply to NieceByMarriage]

That makes sense to me, thanks

[Nimrod2 in reply to NieceByMarriage]

Thank you for this. I have never had it explained to me. 👍

[Purpaidh in reply to NieceByMarriage]

Thank you for explaining this.

[Biker88]

COPD is diagnosed by a CT scan and broncoscopy, asthma is an allergic reaction where as COPD emphysema is physically damaging the lungs hence it shows up in a scan. As mentioned asthma can be managed better if you can identify the main triggers, (bialogics work well with asthma) as yet with COPD inhalers can help but I understand there is some research with using bialogics for COPD.

[PaulineHM]

Hello, it can all be very confusing at first.

How was the Asthma diagnosed for you ? Was it a FENO test or did they use Spirometry which show reversibility with Asthma and no reversibility with COPD. ?

Can I advise that to help gain some clarity with the diagnosis you speak with the Asthma + Lung UK helpline ? The specialist nurses there are very knowledgeable and helpful and can guide you through.

I have a mix of asthma, COPD and bronchiectasis - it gets muddly! Let us know how you get on.

Go well

Pauline

[Frankie4Sanity in reply to PaulineHM]

It was diagnosed after Spirometry and told that was all that was needed. I had a chest xray within last year and this didn't show anything. I've been in touch with Asthma + Lung UK, just waiting for them to come back.

[PaulineHM in reply to Frankie4Sanity]

That is good to know then - usually these days COPD is only diagnosed using Spirometry so if it didn't show up for then great!! A FENO test for Asthma is the gold standard these days for diagnosing Asthma.

I am sure Asthma + Lung UK will be very helpful. Let us know if you like how you get on.

Go well,

Pauline

[Coughingalltheway]

I have also been diagnosed with adult onset asthma with possible COPD overlap earlier this year.

My understanding is that adult onset is slightly different from children's asthma as we have a high eosinophil count most of the time which makes our lungs think that they are under attack from an infection.

It is important to have an inhaler that includes a steroid for asthma as this is the thing that keeps you eosinophils in check whereas steroids do not affect COPD and so are not necessary.

It would be useful to know which inhaler you are currently using and who diagnosed you?

A preventative inhaler is only used twice a day normally where as a rescue inhaler (blue one), you can use up to 4 times a day but this will only give you temporary relief. You should have been prescribed both.

[Frankie4Sanity in reply to Coughingalltheway]

I'm on Symbicort 200, prescribed by Nurse Practitioner. Original prescription was 1 puff morning and evening and then additional puffs if and when required during the day. As not controlling, am on 2 puffs morning, lunch and evening for a week and then down to 2 puffs morning and evening after that. Have been told I can take up to 8 puffs a day.

[Coughingalltheway in reply to Frankie4Sanity]

That is a preventative inhaler that can double up as a rescue one if necessary. I've read that you shouldn't have 8 puffs a day for more than a week but obviously, I'm not a medical professional.

I would recommend asking for an appointment with a respiratory nurse if posssible (I know that it's a terrible time of year for that!). Even GPs usually follow the recommendations from asthma/COPD nurses as it's quite a specialist area.

I hope that you get the help that you need. I'm fighting my own battle atm. It feels like armageddon out there when you're trying to get some help! xx

[Patk1]

I hope new inhaler regime helps.youve done well to cut back to 1 cigarette but perhaps u could knock that off,with help if need be.yr more at risk of restarting while u still have a cig so can understand gp.with yr asthma not yet controlled,u don't want smoke irritating them.gd luck