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Asthma vs COPD

DimensionAsthmaCOPD
OnsetOften young; atopic historyMid-life onward; smoking or exposure history
CourseEpisodic, normal between attacksProgressive with exacerbations
SpirometryObstruction with significant bronchodilator reversibilityObstruction that persists post-bronchodilator
DLCONormal (or high)Reduced in emphysema
InflammationEosinophilic, steroid-responsiveNeutrophilic predominance

Pearls

  • Reversibility and DLCO are the two most discriminating numbers.
  • Overlap exists; longstanding asthma can remodel into fixed obstruction.

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