Asthma and COPD (chronic obstructive pulmonary disease) both narrow the airways and can cause coughing, wheezing and shortness of breath, but they are different diseases. Asthma often starts in childhood, flares with triggers, and the narrowing usually opens up again with treatment. COPD mostly develops after age 40, usually after years of smoking, and causes lung damage that cannot be reversed.

Knowing which one you have matters, because the right daily inhaler is different for each. Here is how doctors tell them apart and how treatment differs.

Asthma vs COPD at a glance

What causes asthma, and what causes COPD?

In asthma, the airways become inflamed, swollen and extra sensitive. Nobody knows the exact cause, but genes and environment both play a part. According to MedlinePlus, the risk is higher with a family history of asthma, allergies, frequent viral respiratory infections in early childhood, secondhand smoke in early life and obesity. Common triggers include pollen, dust mites, mold, pets, cold air, colds, exercise and tobacco smoke.

COPD is an umbrella term for emphysema, where the tiny air sacs are damaged, and chronic bronchitis, where the airways stay inflamed and full of mucus. The NHS explains that smoking is the main cause, and the risk rises the more and the longer you smoke. Long-term exposure to dust or fumes at work can also cause it, as can a rare inherited condition called alpha-1 antitrypsin deficiency.

At what age do asthma and COPD usually start?

Asthma can begin at any age, but it often starts in childhood. COPD usually appears after age 40 and mainly affects middle-aged and older adults who smoke or used to smoke. Doctors see symptoms that began before age 20 as a pointer toward asthma, and symptoms that began after 40 as a pointer toward COPD. Age alone does not settle it, though: a 55-year-old former smoker with new wheezing could have either condition, or both.

How are the symptoms different?

Both conditions can cause cough, wheeze, chest tightness and breathlessness. The pattern usually gives the clue:

• Timing: asthma symptoms tend to come and go, are often worse at night or early in the morning, and may disappear for weeks. COPD symptoms are there most days and creep up slowly over the years, with breathlessness that builds during activity such as climbing stairs.
• Triggers: asthma flares are often clearly linked to allergens, exercise, cold air or a cold. COPD flare-ups are commonly set off by chest infections.
• Cough and mucus: a daily cough that brings up phlegm, often brushed off as a “smoker’s cough,” is typical of COPD.

Is asthma reversible? Is COPD?

This is the key difference. In asthma, the airways narrow because the muscles around them tighten and the lining swells. With the right treatment they usually open up again, and many people breathe close to normally between flare-ups. Years of poorly controlled asthma, however, can leave some narrowing that no longer fully opens.

In COPD, the damage to the airways and air sacs is permanent. COPD cannot be cured or reversed, but treatment can ease symptoms and slow it down, which is why an early diagnosis matters.

How does spirometry tell asthma and COPD apart?

Spirometry is the main breathing test for both conditions. You take a deep breath and blow out as hard and fast as you can into a tube connected to a machine. It measures how much air you blow out in the first second (FEV1) and the total amount (FVC). The test is then repeated after you inhale a reliever such as albuterol (salbutamol).

• Asthma: readings often improve clearly after the reliever. A rise in FEV1 of at least 12% and 200 mL is the usual yardstick, and results may even be normal on a good day. Doctors may add home peak flow readings, a breath test for airway inflammation or allergy tests.
• COPD: the ratio of FEV1 to FVC stays low even after the reliever (below 0.70 is the usual cutoff). Readings may improve a little but do not return to normal.

Doctors combine the results with your symptoms and smoking history, because one test does not always give a clear answer.

What is asthma-COPD overlap?

Some people have features of both, such as someone who had asthma as a child and then smoked for many years. Doctors call this asthma-COPD overlap. A review in the National Library of Medicine notes that it is not a single disease and has no agreed definition, but people with overlap tend to have more frequent and severe flare-ups and a higher risk of hospital stays than people with either condition alone.

Treatment generally follows asthma rules first: guidelines advise that an inhaled steroid should be part of the plan and that long-acting bronchodilators should not be used without one. The review’s authors see a triple inhaler, which combines a steroid with two long-acting bronchodilators, as a suitable option.

How are asthma and COPD treated?

Both conditions use inhalers, but in different ways. The main groups are:

• Relievers (rescue inhalers): short-acting bronchodilators such as albuterol open the airways within minutes and are used in both conditions. In COPD, ipratropium is another short-acting option.
• Inhaled corticosteroids (ICS): budesonide, fluticasone and beclomethasone (beclometasone) calm airway inflammation and are the foundation of asthma treatment. In COPD, they are usually added only for people who keep having flare-ups, partly because they can raise the risk of pneumonia.
• Long-acting beta-agonists (LABA): salmeterol and formoterol keep the airways open for about 12 hours. In asthma they must always be paired with an inhaled steroid: the US label for salmeterol says using it for asthma without one is contraindicated because it raises the risk of asthma-related death. In COPD, the same medicine is approved on its own for twice-daily maintenance.
• Long-acting muscarinic antagonists (LAMA): tiotropium, glycopyrrolate (glycopyrronium) and umeclidinium are a mainstay of COPD treatment. In asthma, a LAMA is an add-on for some people whose symptoms stay uncontrolled on a steroid and a LABA. Our Tiova vs Spiriva guide explains how tiotropium is used.

Many people use combination inhalers. Budesonide/formoterol, for instance, is used for both asthma and COPD; Foracort Inhaler contains the same two active ingredients as Symbicort and is made and licensed in India. Our guide to asthma inhaler types explains how relievers and preventers fit together, and you can browse our asthma medicines and COPD medicines. Your doctor should choose the medicine, strength and device for you.

People with COPD also often benefit from pulmonary rehabilitation, a supervised program of exercise and breathing education.

Why does quitting smoking matter for both?

For anyone with COPD who smokes, stopping is the single most important step. It slows the loss of lung function, and it is worth doing at any age and any stage of the disease.

For asthma, tobacco smoke is a common trigger, and smoking makes asthma harder to control. Nicotine replacement, prescription stop-smoking medicines such as varenicline or bupropion, and counseling all raise your chances of quitting. In the US, the free quitline at 1-800-QUIT-NOW can connect you with support in your state.

When to see a doctor

Book an appointment if you have a cough that will not go away, regular wheezing, breathlessness during everyday activities or frequent chest infections, especially if you are over 35 and smoke or used to. If you already have asthma or COPD, see your doctor if you need your reliever more often than usual or symptoms wake you at night.

Call 911 or go to the emergency room if:

• You are too breathless to speak in full sentences, eat or sleep.
• Your reliever is not helping, or you need it every few minutes.
• Your lips or fingernails look gray or blue.
• You feel confused, very drowsy or have chest pain.

With COPD, contact your doctor the same day if you become more breathless than usual, cough up more phlegm or phlegm that changes color, or develop a fever.

Frequently asked questions

Can asthma turn into COPD?

Asthma does not simply turn into COPD. However, long-standing asthma, especially if poorly controlled or combined with smoking, can leave narrowing that no longer fully reverses, and some people end up with features of both conditions.

Is COPD worse than asthma?

COPD causes permanent damage that tends to get worse over time, while asthma can usually be well controlled. Even so, a severe asthma attack can be life-threatening, so both conditions need regular treatment and follow-up.

Can the same inhaler treat both asthma and COPD?

Some combination inhalers, such as budesonide/formoterol and fluticasone/salmeterol, are used for both. The strength, dose and way they are used can differ, so follow the plan your doctor gives you for your diagnosis.

Can you get COPD if you never smoked?

Yes, although it is less common. Long-term exposure to dust or fumes at work and the inherited condition alpha-1 antitrypsin deficiency can also cause COPD.

This article gives general information only and is not medical advice. Asthma and COPD need a proper diagnosis from a doctor, and prescription medicines should be used under a doctor’s care.

If you have been prescribed a steroid course in the US, it was probably prednisone. In the UK, India and much of the world, doctors usually prescribe prednisolone instead. The names differ by only two letters, and the medicines are closely related. In fact, one turns into the other inside your body. Here is what that means for dosing, when one is preferred over the other, and how to take a steroid course safely.

Prednisolone vs prednisone at a glance

One medicine, two forms

Prednisone has no steroid activity of its own. After you swallow it, enzymes in the liver convert it to prednisolone, which does the work. For people with healthy livers, this conversion is quick and efficient, so prednisone and prednisolone are considered equivalent milligram for milligram: 5 mg of one does the same job as 5 mg of the other. Indian brands such as Omnacortil and Wysolone are prednisolone tablets.

Prednisolone is often chosen when the liver may not convert prednisone reliably, as in severe liver disease, and as a liquid for children because it is available in better-tasting formulations.

Steroid dose equivalents

Doctors use equivalence tables when switching between corticosteroids. These approximate anti-inflammatory equivalents are widely used:

That is why Medrol 4 mg tablets come in that slightly odd strength. Equivalence covers anti-inflammatory effect only; the steroids differ in how long they last and how much salt and water they retain, so switching should always be done by a doctor.

What these steroids are used for

Oral steroids calm inflammation and an overactive immune system quickly. Common reasons for a course include:

• Asthma or COPD flare-ups that do not settle with inhalers
• Severe allergic reactions, hives or hay fever that has not responded to other treatment
• Autoimmune and inflammatory conditions such as rheumatoid arthritis, lupus, inflammatory bowel disease and polymyalgia rheumatica
• Some skin conditions, kidney diseases and blood disorders

For an asthma flare in adults, a typical course is 40 to 50 mg once a day for 5 to 7 days. Children usually receive a dose based on their weight, for a shorter time. Other conditions use very different doses and durations, so always follow your own prescription.

How to take a steroid course

• Take it in the morning, with food. Morning dosing matches the body’s natural cortisol rhythm and causes less sleeplessness.
• Swallow tablets with breakfast to reduce indigestion. Some doctors add a stomach-protecting medicine for longer courses.
• Do not stop suddenly after long use. Courses of more than about three weeks, or frequent repeated courses, suppress the body’s own cortisol production. The dose must then be tapered down gradually. Short courses for a flare can usually be stopped at the end, but follow your doctor’s instructions.
• If you are on long-term steroids, carry a steroid card or wear a medical ID, because extra steroid may be needed during surgery, injury or serious illness.

Side effects

A short course is usually well tolerated. You may notice a bigger appetite, trouble sleeping, mood changes (from feeling energetic to irritable or low), indigestion and higher blood sugar, which matters if you have diabetes. These settle after the course ends.

Long-term use carries more serious risks, which is why doctors aim for the lowest dose for the shortest time: weight gain and a rounded face, thinning bones (osteoporosis), high blood pressure, diabetes, cataracts and glaucoma, thin skin and easy bruising, muscle weakness and a higher risk of infections. People on long-term treatment may need bone protection, eye checks and blood sugar monitoring.

Seek urgent help for black or bloody stools, severe stomach pain, signs of serious infection, sudden vision changes, or severe mood changes including thoughts of self-harm.

Precautions and interactions

• Infections: steroids weaken immune defenses. If you have not had chickenpox or measles, avoid people with these infections and see a doctor promptly after any exposure.
• Vaccines: live vaccines should be avoided during high-dose treatment.
• NSAIDs such as ibuprofen, naproxen and aspirin increase the risk of stomach ulcers and bleeding.
• Diabetes medicines may need adjusting, and warfarin needs closer INR checks.
• Tell your doctor about stomach ulcers, heart failure, high blood pressure, glaucoma, osteoporosis, mental health conditions, tuberculosis or pregnancy.

Frequently asked questions

Is prednisolone stronger than prednisone?

No. At the same milligram dose they have the same effect in most people, because prednisone becomes prednisolone in the liver.

Can I switch from prednisone to prednisolone?

Doctors commonly switch milligram for milligram, for example 20 mg prednisone to 20 mg prednisolone. Confirm with your prescriber, especially if you have liver disease or are tapering.

Is a steroid tablet the same as an anabolic steroid?

No. Prednisolone and prednisone are corticosteroids that reduce inflammation. They are unrelated to the anabolic steroids misused for muscle building.

Can I drink alcohol on a steroid course?

Moderate amounts are usually acceptable on a short course, but alcohol adds to the stomach irritation steroids can cause. Ask your doctor if you are on a long course.

For asthma, inhaled steroids reduce how often oral courses are needed; see our asthma inhaler guide and the allergy range.

This article gives general information and does not replace advice from your doctor. Do not stop a long-term steroid suddenly without medical advice.

Tiotropium is the long-acting bronchodilator at the center of most COPD treatment plans. In the US it is best known as Spiriva, made by Boehringer Ingelheim. In India, Cipla sells it as Tiova, in both capsule and aerosol form. If you are living with COPD and paying for a once-daily inhaler month after month, the cost difference can be large, so it pays to understand how the products compare.

Tiova vs Spiriva at a glance

What tiotropium does

Tiotropium is a long-acting muscarinic antagonist, or LAMA. It blocks acetylcholine, the nerve signal that tightens the muscle around the airways, and its effect lasts a full 24 hours. Taken every day, it makes breathing easier, improves exercise tolerance and, importantly, reduces COPD flare-ups (exacerbations) and the hospital visits that come with them. Large long-term trials have confirmed these benefits.

It does not work fast enough to treat sudden breathlessness. Keep a quick-acting reliever such as albuterol for that, and read our inhaler types guide to see how relievers and maintenance inhalers differ.

Comparing the devices

Capsule inhalers. Tiova Rotacaps contain 18 mcg of tiotropium powder per capsule, the same labeled dose as a Spiriva HandiHaler capsule, and Tiotrop Rotacaps are another capsule option. You load one capsule into the device, pierce it and breathe the powder in. Use each capsule in the device it was designed for, and ask a pharmacist if you are unsure whether your inhaler device suits your capsules.

Spray inhalers. The Tiova Inhaler is a pressurized aerosol that gives 9 mcg per puff; the usual dose is 2 puffs once a day. Spiriva Respimat is a different “soft mist” device with a much smaller labeled dose (2 puffs of 2.5 mcg) because the mist reaches the lungs more efficiently. The numbers are not interchangeable, so never convert between devices on your own.

To see every tiotropium option we carry, with prices, visit our generic Spiriva page.

How to use a tiotropium capsule inhaler

1. Peel open one blister just before use and take out one capsule. Never swallow the capsule.
2. Place it in the chamber and close the device. Pierce or twist as the instructions describe.
3. Breathe out fully, away from the mouthpiece.
4. Seal your lips around the mouthpiece and breathe in deeply. You should hear or feel the capsule rattle as the powder is released.
5. Hold your breath for as long as is comfortable, up to 10 seconds.
6. Breathe in a second time from the same capsule to empty it, then throw it away.

Keep capsules in their blister until the moment you need them; humidity spoils the powder. Store them at room temperature, below 77°F (25°C), and never leave them in a hot car.

Side effects and precautions

Dry mouth is the most common side effect and usually mild. Others include constipation, sore throat, sinus congestion and, rarely, a fast heartbeat. Because tiotropium is an anticholinergic, it can also:

• Worsen urinary retention in men with an enlarged prostate. Report difficulty passing urine or a weak stream.
• Trigger narrow-angle glaucoma. Eye pain, blurred vision, halos around lights or red eyes need urgent attention. Avoid getting the powder or spray in your eyes.
• Build up in kidney disease. People with moderate to severe kidney impairment should be monitored.

Do not use tiotropium with other long-acting anticholinergic inhalers such as umeclidinium, aclidinium or glycopyrrolate, and check with your doctor before using ipratropium at the same time. Stop and get help if breathing gets worse straight after a dose or if you notice swelling of the lips, face or tongue. People with a milk-protein allergy should check the capsule ingredients, since dry-powder capsules often contain lactose.

Getting more from COPD treatment

Medicine is only part of COPD care. These steps make a measurable difference:

• Stop smoking. It is the single most effective way to slow COPD. Free help is available at 1-800-QUIT-NOW in the US.
• Stay up to date with vaccines: flu every year, pneumococcal, COVID-19 and, for older adults, RSV.
• Ask about pulmonary rehabilitation, a supervised exercise and education program that improves breathlessness and stamina.
• Have a written flare-up plan so you know when to start rescue medicines and when to call your doctor.

If tiotropium alone is not enough, doctors often add a long-acting beta-agonist. Duova Rotacaps combine tiotropium with formoterol in one capsule. Browse the full COPD range for other options.

Frequently asked questions

Is Tiova the same as Spiriva?

Both contain tiotropium bromide, and Tiova Rotacaps have the same 18 mcg capsule dose as the HandiHaler. The maker, the devices and the regulatory approval differ.

What time of day should I take tiotropium?

Any time, as long as it is the same time each day. Many people pair it with brushing their teeth in the morning.

Can tiotropium be used for asthma?

Spiriva Respimat is approved in the US as an add-on maintenance treatment for asthma from age 6. Capsule forms are used mainly for COPD. Ask your doctor which applies to you.

What if I miss a dose?

Take it as soon as you remember, but never take two doses in 24 hours.

This article gives general information and does not replace advice from your doctor. If you are too breathless to speak in full sentences, call 911.

Advair is one of the most prescribed controller inhalers in the US, and one of the most expensive. Outside the US, the same GSK product is sold as Seretide, and Cipla in India makes its own version called Seroflo. All three pair fluticasone propionate, an inhaled steroid, with salmeterol, a long-acting bronchodilator. This guide matches up their strengths and devices and explains the rules that keep this combination safe.

Advair, Seretide and Seroflo at a glance

Matching the strengths

The number in each product name refers to the fluticasone content, while the salmeterol dose stays fixed. That makes matching easier than it first looks:

• Dry powder: Advair Diskus 100/50, 250/50 and 500/50 mcg line up with Seretide Accuhaler and with Seroflo Rotacaps or Multihaler 100, 250 and 500, each delivering 50 mcg of salmeterol per inhalation. The dose is one inhalation twice a day.
• Aerosol: each puff of Seroflo Inhaler 50, 125 or 250 contains 25 mcg of salmeterol, like Seretide Evohaler. US Advair HFA labels the amount leaving the mouthpiece instead (45/21, 115/21 and 230/21 mcg), which corresponds to the same products. The dose is two puffs twice a day.

Two puffs of the aerosol and one inhalation of the powder give the same total salmeterol (50 mcg), which is why both devices are taken twice daily and never more often.

What each ingredient does

Fluticasone propionate is a potent inhaled steroid. Used every day, it lowers airway inflammation, cuts the number of asthma attacks and reduces COPD flare-ups. Salmeterol relaxes the airway muscles for about 12 hours. It takes longer to start working than albuterol or formoterol, roughly 10 to 20 minutes, so a fluticasone/salmeterol inhaler is never a rescue inhaler. Keep a fast-acting reliever such as albuterol for sudden symptoms; our Asthalin vs Ventolin guide compares two common options.

Generic Advair in the US

The FDA approved the first generic of Advair Diskus, Wixela Inhub, in 2019, and other generic and authorized generic versions have followed. They are still not cheap for everyone, especially without insurance. Seretide is GSK’s original made for other markets, while Seroflo is manufactured and licensed in India.

All of our fluticasone/salmeterol inhalers are compared with strengths and prices on our generic Advair page.

Which device should you choose?

Seroflo Inhaler is a pressurized aerosol that needs you to press and breathe in at the same moment. A spacer solves timing problems and puts more medicine into the lungs and less in the throat. It suits children, older adults and anyone with a weak breath.

Seroflo Rotacaps are single powder capsules used in a Rotahaler, and the Seroflo Multihaler is a pre-loaded powder device similar to the Diskus. Both are breath-activated, so they need a quick, deep inhalation but no coordination.

The Seretide Accuhaler is GSK’s own powder device, the non-US twin of Advair Diskus.

Dosing rules that matter

• Take it twice a day, about 12 hours apart, even when you feel well.
• Do not take extra doses for symptoms. More salmeterol does not work faster and increases side effects.
• Never use salmeterol, or any long-acting bronchodilator, for asthma without an inhaled steroid. In combination inhalers like these, the steroid is built in.
• Do not combine it with another long-acting bronchodilator such as formoterol, which is found in Foracort and Symbicort.
• For COPD, the US-approved Advair Diskus dose is 250/50 twice daily.
• Rinse your mouth with water and spit after each dose.

Side effects

Common effects include hoarseness, throat irritation, oral thrush, headache and, less often, tremor, palpitations or muscle cramps. People with COPD who use inhaled steroids have a higher risk of pneumonia, so report fever, chills, more mucus or worse breathlessness. High doses used for many years can affect bone density, the eyes (cataracts, glaucoma) and growth in children; your doctor will aim for the lowest dose that keeps you well.

Ritonavir and cobicistat, used in HIV treatment, can raise fluticasone levels enough to cause Cushing’s syndrome and adrenal suppression, a well-documented interaction. Ketoconazole and itraconazole have a similar effect. Tell your doctor about every medicine you take.

When asthma is not under control

If you still need your reliever more than twice a week, wake at night with symptoms or have had a flare needing steroid tablets, your treatment needs review. The answer may be better technique, a higher strength or a different combination. Bring your inhaler to appointments so the nurse can watch you use it. Browse the full asthma range to see other preventer options.

Frequently asked questions

Is Seretide the same as Advair?

Yes, in substance. Seretide is the name GSK uses outside the US for the same fluticasone/salmeterol product.

Can Seroflo replace Advair?

It contains the same ingredients in matching strengths, but it is a different manufacturer’s product. Agree the switch and the device with your doctor.

How soon will I feel better?

Breathing often improves in the first week, but the full preventive effect builds over several weeks of twice-daily use.

Can children use these inhalers?

Advair Diskus 100/50 is approved in the US from age 4. Children usually use the lowest strength, often with a spacer for aerosol inhalers.

This article gives general information and does not replace advice from your doctor. If your reliever is not helping or your lips or fingernails turn blue or gray, call 911.