Wheezing in adults — is it asthma or COPD?

Wheezing — that whistling sound on breathing out — is one of the commonest reasons adults are referred to a pulmonologist. Two conditions account for most of it: asthma and chronic obstructive pulmonary disease (COPD). They sound alike, but the treatment plans, prognosis and even the inhalers are very different.

Asthma — typically

• Starts in childhood or early adulthood
• Symptoms come in episodes, often triggered by dust, pollen, cold air or exercise
• Often associated with allergic rhinitis or eczema
• Lung function returns to near-normal between attacks

COPD — typically

• Starts after age 40, almost always in smokers or biomass-fuel exposure
• Symptoms are slowly progressive rather than episodic
• Morning cough with sputum is common
• Lung function does not fully recover with bronchodilators

How we confirm the diagnosis

A Pulmonary Function Test (PFT) with post-bronchodilator measurement is the single most useful test. Significant reversibility points to asthma; persistent airflow limitation points to COPD. In selected patients we add FOT, fractional exhaled nitric oxide (FeNO) or imaging.

The right label changes everything — from inhaler choice to long-term outlook. If you have been on the same wheeze medication for years without review, it is worth a second opinion.