COPD, Asthma, or Lung Cancer? Sorting Out Symptoms

This page is for people with asthma or COPD (chronic obstructive pulmonary disease, a long-term lung disease that makes it hard to breathe) who wonder when a symptom could mean something new.

COPD, asthma, and lung cancer share their most common symptoms. That is why people with a lung condition can find it hard to know when something new is happening. Cough, wheezing, and breathlessness are daily life with airway disease. The useful question is not "do I have a cough?" but "has my cough changed?" Some changes deserve a fresh look.

All three conditions live in the same organ and disturb the same functions.

NHLBI describes asthma as a chronic condition in which the airways can become inflamed and narrowed at times, making it harder for air to flow out. About 1 in 13 people in the United States have it. Symptoms often flare with triggers such as pollen, exercise, viral infections, or cold air, then ease.

COPD, per NHLBI, is caused by damage to the airways or other parts of the lung. Cigarette smoking is the main cause in the United States. Its symptoms include:

• shortness of breath, especially with activity
• an ongoing cough that may bring up mucus
• wheezing
• chest tightness
• fatigue

COPD is progressive: symptoms develop slowly and worsen over time.

NCI's list of possible signs of non-small cell lung cancer overlaps heavily. Chest discomfort or pain, a cough that doesn't go away or gets worse over time, trouble breathing, and wheezing all appear on it.

The symptom alone cannot settle the question. Changes from your usual pattern are the signal to report.

Asthma tends to come and go. Symptoms flare with a trigger and improve between episodes. COPD tends to be steady and slowly progressive, with flare-ups that bring more coughing, chest tightness, or yellow or green phlegm, then respond to treatment.

If your symptoms follow your known pattern and respond the way they usually do, that is reassuring. Existing lung disease does not need to make you read every wheeze as a warning.

The signals worth acting on are departures from your baseline, and symptoms that airway disease does not explain. From NCI's list for non-small cell lung cancer:

• Blood in sputum, the mucus coughed up from the lungs.
• A cough that does not go away or gets worse over time.
• Hoarseness that persists.
• Weight loss for no known reason, or loss of appetite.
• Trouble swallowing.
• Swelling in the face or the veins of the neck.
• New chest pain, or breathlessness out of proportion to your usual state.

A flare-up that does not respond to your usual treatment also warrants a re-check rather than another round of waiting. People with lung disease sometimes absorb new symptoms into the old diagnosis for months. Say it plainly to your clinician: "This is different from my usual." Our page on lung cancer symptoms goes deeper.

COPD and lung cancer share a major cause, smoking. That means many people with COPD meet the criteria for lung cancer screening, which looks for cancer before symptoms change at all.

The U.S. Preventive Services Task Force (USPSTF) recommends annual screening with low-dose CT (a quick, low-radiation scan of the chest) for adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening stops once a person has not smoked for 15 years. It also stops if a person develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.

Screening has trade-offs, as NCI's screening summary notes. These include false-positive results that can lead to procedures that were not needed, and overdiagnosis of some cancers. Whether it fits you, with your breathing status, is a conversation for your clinician. If you qualify and have never discussed it, raise it at your next visit. See our overview of lung cancer screening.

• Call 911 or get emergency care if you are having a hard time catching your breath or talking, or your lips or fingernails have turned blue or gray. NHLBI also lists reduced mental alertness, a very rapid heartbeat, and flare-up treatment that is not working as emergency signs.
• Call your care team right away if you cough up blood, if a flare-up is not responding to your usual treatment, or if you have fever with worsening cough.
• Book a visit soon, without panic, for a cough that persists or worsens over weeks, unexplained weight loss, persistent hoarseness, or any clear change from your usual symptom pattern. They should be checked rather than watched.

• Non-Small Cell Lung Cancer Treatment (PDQ), Patient Version — National Cancer Institute
• Lung Cancer Screening (PDQ), Patient Version — National Cancer Institute
• Lung Cancer: Screening — U.S. Preventive Services Task Force
• What Is COPD? — National Heart, Lung, and Blood Institute
• COPD Symptoms — National Heart, Lung, and Blood Institute
• What Is Asthma? — National Heart, Lung, and Blood Institute