Expert: Marc Rubin, RPh Asthma Educator - 11/20/2009

Question
Eight years ago I woke up in the morning unable to breathe.  There was no wheezing and I hadn't been sick.  My neighbor...an Asthmatic...let me use her inhaler and, after a few minutes, my breathing got better.  Later that evening, though, it happened again...without warning and suddenly.  Again...no wheezing.  It just felt like only the top ¼ of my lungs had room for air.  This time I went to the hospital and was told I was having a “silent Asthma attack”....(is there such a thing?).  The doctor said that there were 2 types of Asthma attacks.  The ones that involved wheezing (and usually caused by an URS infection, allergies or environmental).  I was put on Singulair, Advair, Combivent and Ipratropium/Albuterol nebulizer solution.  Within the next 4 years I only had 1 more attack like that first one, but I had several of the wheezing kind (sometimes there was thick phlegm and sometimes there wasn't even though my lungs sounded like a violin orchestra) that landed me in the hospital on an average of 3 times a year.  Six months ago I had to change doctors and the doctor I am seeing now has told me that I was misdiagnosed all those years ago and that I have COPD/Emphysema..not Asthma.  He has made only 2 changes in my meds....Albuterol instead of Combivent and the addition of Spiriva.   I am confused about a few things.  According to everything I have read, the difference between the 2 is that Asthma presents its symptoms in the form of intermittent attacks while COPD/Emphysema symptoms are constant.  While I do have a cough probably 85% of the time (yes...I used to be a smoker) I only feel “congested” or tightness in my chest maybe 2 or 3 times a week (depending on environmental conditions, amount of exercise, etc.) and my cough rarely produces any phlegm (and when it does....unless I am sick...it is usually clear.).  I asked my new doctor these questions and he simply told me not to worry about it....to trust him he knows what he is doing (which I thought was a little weird).  So which diagnosis should I believe?  I realize the treatment hasn't really changed but I also know that the prognosis for Asthma and COPD/Emphysema are very different and I'd really like to know what to expect in my future (by the way...I'm 58).  Can you help me make sense of this?


Answer
Hi Candy,

Your current MD is likely to be correct, based upon your history and symptom presentation. The one piece of the puzzle here that is missing is the results of a spirometry lung function test to confirm the diagnosis.

Both diseases are considered "restrictive airway" diseases, but s significant difference is that in asthma, it is mostly reversible restriction, where with COPD, you only get partial improvement due to destruction of lung tissue, and remodeling of the airway structures with scar tissue that replaces the normal air pathways.

Asthma "may" eventually become COPD in some patients, based upon a number of issues, but it is not an automatic prognosis.

For your future, there are a number of things you can do. First, and you have already begun it, is to become more educated about the disease. Very shortly, Emmi Solutions will have an updated educational series on COPD completed. I'm waiting on the final draft to complete the review. Once available, I'll contact you in a follow-up reply to get your contact info, if you wish. The program is free, and without any advertising.

Second, I'm hoping you have quit smoking. This is the biggest challenge, but it reaps the greatest rewards, by decreasing the rate of further lung damage. In addition, your lung function will improve as the junk gradually clears out. What is destroyed is gone, but what is left will exchange oxygen more freely. Imagine REALLY dirty glasses. Clean them completely, and you can see again.

Third, use your medication properly, and have the MD check your technique. Also keep the MD informed of lung infections. Uncontrolled, they may further damage your lungs.

Fourth, if you have a lot of breathing difficulty, or it progresses that way, pulmonary rehab teaches you breathing techniques which will improve your quality of life.

I hope this helps for starters.

If you have further questions, please get back to me.

Sincerely,

Marc