Does chronic asthma cause COPD-like symptoms at age 26?

Question

Hello doctor,

My friend is 26 and has had asthma since he was a child. We were recently told he might have signs of COPD, which surprised us because he has never smoked.

We want to understand this better, since we thought COPD was usually linked to smoking. Could you explain how someone young and who does not smoke, but has asthma, might develop COPD-like changes? We are especially interested to know if having asthma for a long time, or if it is not well controlled, can lead to this kind of overlap.

We would greatly appreciate any guidance you can provide.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com

I read your query and understand your concern.

This might seem confusing at first, but it does happen in clinical practice. People who have had asthma for many years, even since childhood, can develop changes in their airways that cause more lasting airflow problems. This is often called Asthma-COPD Overlap, and it can occur even if the person has never smoked.

When asthma lasts for many years or is not well controlled, the airways stay inflamed. Over time, this ongoing inflammation can cause structural changes in the bronchial walls, called airway remodeling. Because of this, the narrowing of the airways may not improve as easily, which is a feature more often seen in Chronic Obstructive Pulmonary Disease (COPD).

In simple terms, asthma usually causes airway narrowing that can change and often gets better with treatment. But if inflammation lasts a long time, some fixed narrowing can develop. That is why doctors may sometimes see 'COPD-like features' even in young people who do not smoke.

I have noticed similar patterns in some young patients who have had asthma for a long time, especially when their treatment was irregular or not ideal. Later, their lung tests showed fixed airflow limitation. This does not mean they have the usual smoking-related COPD, but rather an overlap of asthma with chronic obstructive changes.

I hope this explanation helps.

If you have more questions, please feel free to ask.

Thank you.