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Distinguishing asthma and COPD

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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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