Chronic Obstructive Pulmonary Disease vs Asthma
Chronic Obstructive Pulmonary Disease and Asthma are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Chronic Obstructive Pulmonary Disease vs Asthma at a glance
- Chronic Obstructive Pulmonary Disease: Progressive, largely irreversible airflow limitation from chronic bronchitis and/or emphysema.
- Asthma: Chronic reversible airway inflammation with episodic bronchoconstriction.
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Side-by-side comparison
| Feature | Chronic Obstructive Pulmonary Disease | Asthma |
|---|---|---|
| At a glance | Progressive, largely irreversible airflow limitation from chronic bronchitis and/or emphysema. | Chronic reversible airway inflammation with episodic bronchoconstriction. |
| Classic presentation | Hoover sign (paradoxical inward movement of lower ribs on inspiration), 'tripod' posture, prolonged expiration.; Chronic productive cough (chronic bronchitis:… | Wheezing that improves with short-acting beta-agonist; nocturnal cough; symptom relief between episodes.; Episodic wheeze, cough (often nocturnal), chest… |
| Workup / key labs | GOLD 2024: symptoms + risk factor exposure + post-bronchodilator FEV1/FVC <0.7. Severity by FEV1 % predicted; clinical group (E, A, B) by symptoms (mMRC, CAT)… | GINA: history of variable respiratory symptoms + confirmed variable expiratory airflow limitation (bronchodilator reversibility, methacholine positivity, or… |
| Imaging | CXR — hyperinflation (flattened diaphragms, >9 posterior ribs visible), increased AP diameter, bullae; CT chest — emphysema pattern (centrilobular,… | CXR — usually normal or hyperinflation; obtain to exclude alternative diagnoses or complications (pneumothorax, pneumonia); HRCT if bronchiectasis or… |
| First-line treatment | Smoking cessation — single most important intervention; reduces rate of FEV1 decline; Pulmonary rehabilitation for mMRC ≥2 or after exacerbation;… | GINA 2024 has eliminated SABA-only treatment; all adults and adolescents should receive ICS-containing therapy; Step 1-2 (mild): low-dose ICS-formoterol PRN… |
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