hearts on the left merge with lungs on the right and overlap

Are Your Symptoms Caused by Heart Failure or Asthma?

Asthma is not heart failure. Heart failure is not asthma. The treatment for both conditions is different. Still, they both share common symptoms of shortness of breath, coughing, and wheezing. So, how do doctors tell the difference between asthma and heart failure? How do they determine which disease to treat you for? Here’s what to know.

What is asthma?

Asthma is a disease of an abnormal immune system response. The immune systems of asthmatics are overactive. Immune systems are supposed to protect you against foreign invaders. You inhale a virus and it initiates a response. This response causes inflammation. This inflammation helps to kill and remove pathogens from your lungs. It also causes symptoms such as common cold symptoms.1-4

Asthma occurs when the immune system attacks harmless substances, such as common allergens like dust mites, mold spores, animal dander, and certain foods. This response causes inflammation of your airways, irritating smooth muscles wrapped around airways which causes them to spasm. This makes them squeeze airways, thereby causing airway obstructions. Inflammation also causes swelling and increased mucus production which can further obstruct airways. Air can get in past the obstructions but has a hard time getting out. This causes a feeling that you can’t catch your breath. As air moves through obstructed airways it causes a wheeze.3-4

Thankfully, in our modern world, we have many great asthma medicines. Asthma attacks can be quickly ended with rescue medicine like albuterol. These are medicines that tell smooth muscles to relax, opening airways and allowing air to move more freely through them. They can also be ended with corticosteroids that reduce airway inflammation.4

Also, there are asthma controller medicines to prevent asthma from occurring. Taking asthma controller medicines every day can help most asthmatics obtain good asthma control. This allows most asthmatics to live relatively normal lives.4

How do doctors know if you have heart failure or asthma?

There are various strategies for helping physicians tell the difference between asthma and heart failure.

Listening to lung sounds

Both may present with shortness of breath and/or coughing. Upon listening to the lungs, a physician may hear wheezing on expiration. However, since heart failure may also consist of fluid in the lungs (pulmonary edema), a lung sound called coarse may be heard. This is a sound indicating fluid in the lungs. Asthma may also present with inspiratory wheezes.4-7

Assessment of the body

People with both conditions may appear to be working hard to breathe. Those experiencing heart failure may have a hard time breathing while lying flat. Their feet and ankles may be swollen. Their stomachs may appear bloated. Asthma usually does not present with a bloated stomach or feet or ankle swelling.7-8

Tests

X-ray for heart failure may show pulmonary edema. X-ray for asthma is often normal. Although, if someone is having a severe asthma attack, it may show hyperinflation of the lungs. Hyperinflation basically means that there is air trapping. This may be due to the fact that asthmatics have a difficult time exhaling through obstructed airways. A test called a BNP may indicate heart failure. It should be normal in asthmatics. An echocardiogram is another test to confirm heart failure. A test called a pulmonary function test is often used to diagnose asthma.4,7-10

Patient history

Patients with a history of heart disease should be monitored for heart failure. This is also true for those with a history of abnormal heart rhythms, such as atrial fibrillation. Asthma may be considered in those with a history of asthma. For instance, one or both of their parents also has asthma. (4, 7, 10)

Treatment

Heart failure is treated differently from asthma. It responds well to medicines that make your heart a stronger pump. It also responds well to medicines that make you pee (diuretics). Diuretics can help resolve pulmonary edema. Asthma is treated with rescue medicine like albuterol. This is a medicine that is inhaled using an inhaler or breathing treatment. Corticosteroids are also helpful for reducing airway inflammation.

Differential diagnosis

Oftentimes, ruling in one disease is accomplished by ruling out others. Breathing treatments are easy to give patients. They also work very fast. So patients experiencing shortness of breath may be given a breathing treatment before testing can be performed. If the treatment helps, this may indicate asthma. If not, it may rule out asthma and causes the team to consider other conditions, such as heart failure. In the same way, an x-ray and echocardiograms can rule out asthma and rule in heart failure.

Similar and different

Some of the symptoms of heart failure are similar to asthma. As you now know, physicians have access to various strategies for differentiating between these two different diseases. Because treatment for both diseases is different, this makes getting to that proper diagnosis all the more important.

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