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Chip Gatchell, 68, spent much of his life working in theglass industry. For many years he worked with con-struction crews, created decorative glasswork, andeven developed a photography-based engravingprocess.“My father had a very good friend who usedto do the old hand-wheel engraving on glass, and Ibecame fascinated with it,” he explained.“Myprocess, however, was photo-based, and involvedsandblasting, among other things. Later on that

became my primary self-employment. I did a lot ofwork in glass, but primarily in granite and other stoneproducts.” Gatchell also smoked for more than fortyyears. According to his doctors, the combination ofglass dust when he was a child; the sand, dirt, anddust from sandblasting; and the lifelong cigarettehabit formed a very nasty combination that led to hisbeing diagnosed with chronic obstructive pulmonarydisease (COPD).

By Mark Terry

COPD and Asthma: Similar Wheeze, Different DiseaseDistinguishing Between COPD and Asthma,

and Their Different Treatments

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COPD VersusAsthma

There is understandableconfusion between asthmaand COPD. Both involverestriction or obstruction ofthe airways in the lungs lead-ing to difficulty breathing.However, there are a numberof differences betweenCOPD and asthma. COPDis a broader condition thatincludes emphysema andchronic bronchitis. At thecellular level, the inflamma-tory pathways are different,different cells are involved, and thetissue and cell destruction is differ-ent. There are also different causes.Yet, from a diagnostic point of view,the most important part of the diag-nosis involves the question: Does it goaway with treatment?

William C. Bailey, MD, professorof medicine and director of the Lung Health Center atthe University of Alabama, Birmingham, AL, explains itthis way. “Primarily, COPD is a disease that includes acomponent of fixed airflow obstruction. Even thoughthere may be [some] reversibility to it, it’s not complete-ly reversible. In most cases, asthma is a disease of period-ic airflow obstruction. Most of the time asthma is moreor less completely reversible.”

Gatchell, who is the co-founder and director ofCOPD International, an online support group forCOPD sufferers, says, “Asthma, in and of itself, tendsnot to be permanent. It fluctuates a great deal depend-ing on [various triggers]—dust, pollen, and the list goeson and on. The primary culprit in COPD is emphyse-ma, and unfortunately that is a permanent condition—whatever damage is done does not improve.”

In other words, with asthma, lung function returns tonormal between attacks and the airway obstruction canbe reversed with the appropriate medications. WithCOPD, there is a permanent decrease in lung function.

Diagnosing COPDCOPD is fairly straightforward to diagnose. First, the

physician looks at three primary symptoms: cough, spu-tum production, and shortness of breath.

“Patients with a history of smoking are the biggestissue,” says Steven Gay, MD, MS, medical director ofCritical Care Support Services and associate director ofthe Lung Transplant Patient Program at the Universityof Michigan Health System, Ann Arbor, MI. “You also

begin to think COPD in anolder population.”

Taking a spirometry orlung function test is impor-tant in the diagnosis ofCOPD. Any smoker or for-mer smoker over the age of40 with these symptoms—cough, sputum production,or shortness of breath—should have a lung functiontest performed. “It’s reallyjust a question of taking adeep breath and blowing outhard and fast and measuringthe volumes and the flow

rates,” says Dr. Bailey. “You can mea-sure a couple of numbers, usually thetotal amount [of air] you can hold inyour lungs and the amount you canget out in one second. With thosetwo numbers you can pretty well seeif the patient has airflow obstruction.”Once airway obstruction has been

established, a chest X-ray may be done to rule out otherconditions that have similar symptoms.

Chip Gatchell explains, “Many COPDers are diag-nosed right at the time of an emergency room visit forsomething like pneumonia or chronic bronchitis. Theirbreathing got so bad that they’ve either gone to the hos-pital themselves or been driven there by ambulance.Many come out of the hospital on oxygen but with noknowledge [of the disease].” Gatchell says that it isimportant to get diagnosed before things reach this crisispoint. He notes that a pulmonary function test is easyto have done and relatively inexpensive.

A medical history is also an important part of diagnos-ing COPD, especially if there’s a history of smoking.There are also occupational risks, although that is not asprominent as it once was in the United States. “Smoking,”says Dr. Bailey, “is almost always the predominant cause inthe United States and the developed world.”

Treating COPDAlthough there are similarities between asthma and

COPD symptoms, the treatments are different. “It’simportant to distinguish between the two diseases,” saysDr. Bailey, “because there are variations between thetreatments.” Asthma, he points out, is now understoodto be an inflammatory disease of the airways. Currenttreatment protocols usually involve the use of inhaledcorticosteroids to treat the inflammation. “You do that totry and reduce the frequency of the episodes—the bron-chospasms,” says Dr. Bailey. “For many years we used to

There is almost always a history of

smoking in those diagnosed with

COPD. It is important that a

patient obtain a proper diagnosis

of COPD in order to receive

appropriate treatment.

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treat asthma [only] with bronchodilators. People used totake medicine just when they wheezed. Now we knowthat…it’s better to try and prevent the episode by usinginhaled corticsteroids on a regular basis. So the primarytreatment for asthma would be an inhaled corticos-teroid—an anti-inflammatory.”

The treatment of choice for COPD, however, isbronchodilation. There are two primary types of bron-chodilators. First there are beta2-agonists, both short-acting and long-acting. The short-acting ones, such asalbuterol, start to work very quickly but only last fourhours. The long-acting bronchodilators, such as salme-terol (Serevent) take longer to have an effect (approxi-mately 30 minutes for salmeterol), but their effects lastfor 12 hours or more. These may be more effective andmore convenient. Second, there are anticholinergicbronchodilators, such as ipratropium bromide(Atrovent). These also relax and open the airways, butthey work in a different way.

“Long-acting bronchodilators can be used in asth-ma,” says Dr. Bailey, “but are more often used as theprimary treatment of COPD. The main thing we do totreat COPD is open up the airways as much as we can.Bronchodilation is the first step, with the application ofone or two good bronchodilators.”

One medication that is commonly used to treatCOPD is Combivent. Combivent is a formula that com-bines two medications, a short-acting bronchodilator andan anticholinergic, into one inhaler. There are also sec-ondary medications used in the treatment of COPD.Corticosteroids may be used to help with inflammationand antibiotics may be needed when infections develop.

Dr. Bailey points out that behavioral changes arealso important for a person diagnosed with COPD.The most important thing is for the patient to do isquit smoking. Dr. Gay agrees, adding, “If [a healthyindividual] stops smoking, within one year you getback to lung function as if you’d never smoked. So abig part of COPD treatment is to stop smoking.”Quitting smoking, as well as avoiding other environ-mental exposures that may be contributing to the dis-ease, may actually help to slow the progression of thedisease. Also, exercise is important for people withCOPD. Aerobic exercise helps increase the delivery ofoxygen to the muscles and increases a person’s generalhealth. People with COPD should consult with theirhealth care provider prior to beginning an exercise reg-imen to learn which exercises would be appropriateand safe, given their specific condition.

Patients with severe COPD may require supplemen-tal oxygen. Chip Gatchell has both components ofCOPD—emphysema and chronic bronchitis—as well aschronic asthma. Along with medication, he’s on oxygenaround the clock. His lung function is about 20% of

what someone in his age group should be. “It slows medown, obviously,” he says. “But, I am one of those whowill not give in to it. The end result is I have portable[oxygen] systems so I’m able to get out. I’m out andaround virtually every day. The limiting factors are suchthings as stairs, and obviously I can’t run a marathon.But, if somebody comes up with a 26-mile hose for myoxygen, I might give it a shot.”

Dr. Bailey notes that some people are afraid to go onoxygen, thinking it may be addictive or they willbecome dependent on it. “It really is a useful thingwhen you need it,” he says. “Now only the most severepatients need that, but it’s really important to encouragepeople once they get to the point of needing oxygen, touse it, because it’ll reduce the frequency of hospitaliza-tions and prolong life.”

Getting HelpFor all the similarities between the symptoms of

asthma and COPD, it’s important that a patientobtain a proper diagnosis of COPD in order to receiveappropriate treatment. “It needs to be very clear,” saysDr. Gay. “Asthma and COPD are not the same disor-der. They are different disorders and require differentapproaches to treatment. It’s very important thatpatients understand and know this so they get theright treatment.”

Chip Gatchell often speaks to the public aboutCOPD. He notes that, “Somewhere along the line adoctor diagnosed us because we were complainingabout shortness of breath, and many, many of us hidour heads in the sand. You know, I [understand that].For two years I put my head in the sand.” But,Gatchell points out, eventually one needs to acceptthe diagnosis of COPD and get proper treatment. It’simportant to see a pulmonologist. The pulmonologistcan sit down and develop with the patient a plan toimprove the symptoms and perhaps even slow downthe progression of the disease. Gatchell stresses howimportant this is. “Something can be done to improveyour quality of life, to extend your quality of life, andto possibly minimize the damage done by COPD.”

Mark Terry is a freelance writer and editor specializing inhealth and medicine. He is also a novelist. His latest novelis Dirty Deeds.

Reprint requests: Elsevier Inc., 11830 Westline Industrial Dr., St.Louis, MO 63146-3318; phone 314-453-4350.doi:10.1016/j.asthmamag.2005.06.001