Do I have COPD?

Yes, this idea has been bandied about by my doctors. In fact, my Internist actually wrote COPD as my diagnosis in my chart following one of my visits. But, I figured it was in error. Or, I figured it was for billing purposes. But, is it possible my asthma has progressed to COPD? Let’s discuss.

About me: Why I write about COPD

I don't know if I’ve ever truly introduced myself to this site. What gives me the right to write about COPD anyway. Well, I did write two posts about me being a respiratory therapist. But, I am also a lifelong asthmatic. I have experienced all the symptoms that people with COPD experience: mild shortness of breath, severe shortness of breath, coughing, throat clearing, and chest tightness. Oh, and also wheezing, but many times no wheezing at all. As with you COPD folks, we asthmatics don’t always wheeze.

I have had asthma since 1972. I was 2 years old when diagnosed. Mom says I sniffled, sneezed, and acted like I always had a cold before that. I was also a loud breather, and this very much so irritated my brothers. So, for this reason, I was always allowed to sit in the front seat of the car (Or, back in the 70s, this meant standing in the front seat. Mom's extended arm was the seat belt. Safe? Back then it was.). This was a rule mom made because my brothers teased me because of my breathing.

Back in the 1970s and 1980s there were medicines for treating asthma. But, it was treated as an acute disease. You never took medicine unless you were experiencing symptoms. This was mainly due to fears that inhaled corticosteroids (now known to be safe and effective) might not be safe. So, doctors would put me on this medicine only when I was experiencing symptoms.

And, when I experienced symptoms, my symptoms were severe. It was awful. There were times I’d have symptoms weekly. And, I would be barely able to take in half a breath. My lung function in 1984 was 34%. It did not improve with treatment. My asthma was defined as brittle or high risk. And, while I blacked this out for nearly 30 years, I spent six months in a hospital once for this high-risk asthma. No fun indeed. If you're bored enough, you can read my "Pithy Asthma Hospital Story."

Have I always had COPD?

Yes, I had COPD when I was a kid, sort of.

In a sense, I had COPD in reverse. As I got older, my asthma got better. It got better after spending time at that asthma hospital. That was when I was introduced to asthma controller medicines. From then on, my asthma was much better controlled. But, it still plagued me.

So, my asthma got better over time. It became controlled, although good control eluded me until the early 2000s. So, my asthma got better with time. As you know, that’s the opposite of COPD, which is a progressive disease. My asthma got better. Medicines got better. Asthma wisdom got better. And, by the time I was thirty, my asthma was pretty well controlled. This was to the point I once quipped, "I Sold My Asthma." But I ended with the caveat, "Yeah, not really."

From uncontrolled asthma to COPD?

I still have bad asthma attacks sometimes. And there’s this saying I hear sometimes. It’s that severe, uncontrolled asthma may evolve somehow to COPD. Asthma involves inflammation. This inflammation is persistent. When it gets severe enough, it can cause airway scarring. I actually wrote a post a while back on how asthma can lead to thickening of airway walls. If you're interested, you can read, "What Causes Airway Remodeling?"

And what happens when airway wall get thicker? Airway walls get chronically narrowed. And that’s similar to what happens in COPD. So, a 2004 study showed that asthmatics are 10 times more likely to develop chronic bronchitis than non-asthmatics. That's a pretty impressive statistic.¹

There's other impressive statistic that came out of that same study. It's that asthmatics are also 12% more likely to develop emphysema, and 12.5% more likely to develop COPD, than non-asthmatics.¹ So, that's something to at least think about. Hence, why my doctors have noted it a time or two.

Last night I had my first really bad asthma attack in several years. It started about three weeks ago with a chronic cough (just like COPD). It progressed to me being unable to walk from my couch to my kitchen without feeling very short of breath. I caved and went to the emergency room.

The doctor made me feel better. But, as he was talking to me, he said, “I treated you today similar to how I treat people with COPD. I put you on high dose steroids for five days. That’s what I prescribed. I think you will benefit from that. But, there is a fine line between asthma and COPD, especially when you’ve had asthma-like you have for so long. I’m not saying you have COPD, but there is a fine line there."

Scary to hear, but I think it's good for doctors to be honest like that. Honesty is the best road to a proper diagnosis. And a proper diagnosis is the best track to the best treatment options.

Has my asthma progressed to COPD?

Who knows? I'm not a doctor, so I don't like to self diagnose myself. Sure, a few doctors have bandied about the idea of my asthma progressing to COPD. But, the last time I had a PFT, it showed any airflow limitation I have is completely reversible with treatment. Likewise, my lung function between attacks is 80% or better. So, that doesn't indicate COPD. But, it's been about five years since I've had a PFT. So, I guess the only way to find out would be for a doctor to order another one for me.

I will tell you what. I have hung around COPD patients for 20 years now. I also spend lots of time in this community. Plus I have asthma. And when you have a chronic disease like ours, you learn to cope. You learn how to do things you enjoy. You learn how to get the most out of life. So, if it does eventually come out that I also have COPD, I will cope just like all of us do.

Sometimes, as we age, our body's change. But, we don't change. We are still who we are. We are still wonderful people trying to get the most out of this life. And, if it comes to it, I can still write. I can write even as I suffer from this stupid asthma flare-up that has my doctor thinking COPD. I will cope. That's what people with chronic diseases do, we cope.