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Asthma vs Chronic Obstructive Pulmonary Disease (COPD): Clinical Insights for Differential Management Updated According to GINA 2025 & GOLD 2026 Guidelines   Introduction   Asthma and Chronic Obstructive Pulmonary Disease (COPD) are common chronic respiratory conditions characterized by airflow limitation. Although they may share overlapping clinical features, their underlying pathophysiology, disease course, and management strategies differ substantially.[1] Accurate differentiation between asthma and COPD is crucial to ensure correct diagnosis, appropriate treatment selection, and effective patient education, as misclassification can lead to suboptimal outcomes.   Etiology and Onset   Asthma is a complex, chronic inflammatory disease of the airways, with etiology and onset driven by a multifaceted interplay of genetic predisposition and environmental factors.  Asthma most often begins in childhood, a time when the immune system is still developing. However, some individuals do not experience symptoms until later in life, a condition referred to as adult-onset asthma.[1][2] Similar to asthma, COPD is mainly caused by genetic and environmental factors. The main environmental risks include tobacco smoking and exposure to toxic particles. The most common known genetic risk factor for COPD is the mutation in the SERPINA1 gene that leads to α-1 antitrypsin deficiency.  In addition, several other genetic variants have been linked to reduced lung function and increased COPD risk, though their individual effects are generally small.[3]   Pathophysiological difference between Asthma & COPD   Asthma is primarily driven by eosinophilic inflammation in the larger airways, leading to airway hyperresponsiveness and airflow obstruction that is usually reversible, and is commonly associated with allergies. In contrast, COPD is characterized by neutrophilic inflammation affecting the small airways and lung tissue, leading to emphysema and excess mucus production, and

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