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Distinguishing asthma and COPD

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Distinguishing COPD from asthma is mostly carried out on the basis of patient history and examination. The following features should be used to differentiate the two conditions whenever possible (1):

COPD

Asthma

smoker or ex-smoker

nearly all

Possibly

symptoms under age of 35

rare

often

chronic productive cough

common

uncommon

breathlessness

persistent and progressive

variable

night time waking with breathlessness and/or wheeze

uncommon

common

significant diurnal or day to day variability of symptoms

uncommon

common

In case of a diagnostic doubt, the following can be done to differentiate between the two conditions:

  • serial domiciliary peak flow measurements
    • shows a 20% or greater diurnal or day-to-day variability
  • reversibility test using bronchodilators and corticosteroids can be used to separate asthma patients from those with COPD.
    • a large (>400 ml) response to bronchodilators
    • a large (>400 ml) response to 30 mg oral prednisolone daily for 2 weeks

Reference:

  1. National Institute for Health and Clinical Excellence (NICE) 2019. Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults in primary and secondary care.

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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