Chronic bronchitis and emphysema are two conditions found in people with chronic obstructive pulmonary disease (COPD). Although chronic bronchitis and emphysema usually occur together and may cause similar symptoms, they are two distinct diseases.
“There is a fine line between emphysema and bronchitis,” wrote one MyCOPDTeam member. “I just had X-rays done to see which one I do have.”
The main difference between chronic bronchitis and emphysema is how they impact the lungs and affect your breathing. That, in turn, creates differences in their respective diagnoses and treatments.
If you are living with COPD and have emphysema, bronchitis, or both, it helps to know about how they differ and how they each can be managed. Importantly, always speak with your health care provider before making any changes to your treatment plan.
In emphysema, the walls between the alveoli (tiny air sacs in the lungs where oxygen is exchanged) are destroyed, causing the sacs to expand. Air becomes trapped inside the lungs, which leads to breathing difficulties. Emphysema makes it difficult to exchange carbon dioxide for oxygen.
According to Mayo Clinic, airborne irritants are the most common cause of emphysema, coming from:
Emphysema may also be caused by the genetic disorder alpha-1 antitrypsin deficiency, or alpha-1.
In chronic bronchitis, the airways respond to irritation by becoming inflamed and producing mucus. The airways become blocked, causing shortness of breath, phlegm production, wheezing, and chest pains. Chronic bronchitis is caused by irritation to the lungs from:
While chronic bronchitis and emphysema share many of the same symptoms, their main symptoms differ.
Chronic bronchitis is characterized by a persistent cough that produces mucus (called a productive cough) and that lasts for three months or more per year over the course of two years. Chronic bronchitis causes inflammation and irritation in the bronchial tubes, which link the lungs to the windpipe. This inflammation leads to the overproduction of mucus, which has to be excreted, leading to a chronic cough.
The main symptom of emphysema, on the other hand, is shortness of breath. When the condition causes air sacs in the lungs to rupture, it creates large air spaces and reduces the sacs’ surface areas. This, in turn, reduces the lungs’ ability to absorb oxygen from the air. Reduced oxygen in the bloodstream causes shortness of breath, beginning gradually at first and progressing over time. Eventually, emphysema can cause shortness of breath in a person who is just at rest.
“If I walk slowly and don't panic, I can walk longer that way,” one MyCOPDTeam member told another. “But don't talk to me, then everything goes wrong … Huff and puff and can't breathe.”
Chronic bronchitis and emphysema have many similar symptoms. The symptoms of COPD develop slowly, often remaining unnoticeable until significant lung damage has occurred. When symptoms do start to occur, people with COPD may experience periods when their symptoms become worse than usual. These episodes, known as exacerbations, last for at least several days.
As COPD conditions, chronic bronchitis and emphysema both cause difficulty breathing during exercise and everyday activities. Frequent coughing is also common as the body attempts to get rid of excess mucus in the lungs through the airways.
“A woman sat down behind me at breakfast Sunday with strong perfume. I started coughing and couldn’t quit … ,” wrote a MyCOPDTeam member. “Had to get up and go outside. I’m glad I was through eating.”
Wheezing is also common in both chronic bronchitis and emphysema. Wheezing is the high-pitched whistling sound made as the result of obstruction or inflammation in the airways.
In severe cases, both forms of COPD can cause heart problems. As the body absorbs less and less oxygen due to COPD, the blood pressure in the arteries of the lungs rises, leading to a condition known as pulmonary hypertension. As a result, the heart’s right ventricle is forced to exert more pressure in order to pump blood through the lungs. Over time, it weakens, causing right-sided heart failure.
Some people may develop emphysema as the result of a genetic condition, known as alpha-1 antitrypsin deficiency The signs and symptoms of the alpha-1 antitrypsin deficiency include wheezing and shortness of breath after mild activity. Symptoms may appear first between the ages of 20 and 50.
Beyond genetics, chronic bronchitis and emphysema share many of the same causes and risk factors.
The leading cause of both chronic bronchitis and emphysema is cigarette smoke. Approximately 85 percent to 90 percent of all COPD cases may result from smoking cigarettes, according to the American Lung Association. The burning of a cigarette produces more than 7,000 chemicals. These chemicals have many harmful effects on the respiratory system, including:
Environmental pollutants can also put you at risk for COPD. Breathing air pollution and irritants such as dust, fumes, chemicals, and second-hand smoke can lead to the development of chronic bronchitis and emphysema.
Men are generally more likely to develop COPD than women, though the reasons may have to do more with lifestyle than biology, experts believe.
People are more likely to develop COPD as they get older. This is partly due to the increasing number of irritants a person is exposed to over time, as well as the duration of their exposure.
People who experienced frequent lung infections in their childhood are at a higher risk of developing COPD than those who did not.
Different criteria often help doctors differentiate chronic bronchitis and emphysema. Typically, COPD is diagnosed by spirometry, which is a test that measures how much air you can breathe out.
A diagnosis of chronic bronchitis can be made when a person has a persistent productive cough lasting for at least three months over two consecutive years. The doctor may also conduct tests to rule out the possibility that infections or other diseases are causing the symptoms.
Emphysema, which causes the lungs’ air spaces to become larger, can be detected through imaging tests. X-rays can also be used to rule out the possibility that other lung problems or heart failure are behind the symptoms. Additionally, CT scans can be helpful in detecting emphysema, as can some lab tests. You may, for instance, be tested for alpha-1-antitrypsin deficiency emphysema if you have a family history and develop the condition at an abnormally young age.
If you experience symptoms such as shortness of breath, wheezing, or coughing, your doctor may order other types of tests used to diagnose and track the progression of COPD, including emphysema or chronic bronchitis. Read more about diagnosing COPD.
There is no known cure for either chronic bronchitis or emphysema. However, treatment — which is similar for both conditions — can help slow the progression, manage the symptoms, and decrease the frequency of flares, making it easier to live with chronic bronchitis or emphysema.
One difference is that surgery may be recommended for people with some forms of severe emphysema that don’t improve sufficiently with medication. A bullectomy, for instance, can be performed to remove damaged air sacs and improve breathing. In rare cases, an individual with emphysema may need a lung transplant.
Other treatments for both conditions include:
Because COPD is a progressive disease, it’s important to start treatment as early as possible. Read more about treatment for COPD.
The right support can make all the difference when living with a chronic lung condition. By joining MyCOPDTeam, you’ll become part of a social network for people living with chronic bronchitis, emphysema, and other types of COPD. Here, you can ask questions, share your story, and talk with more than 109,000 members who understand life with COPD.
Do you have chronic bronchitis or emphysema? Members would love to hear from you. Share your story in the comments below, or connect with others by posting on MyCOPDTeam.