The Difference Between Chronic Bronchitis vs. Emphysema

In 2018, chronic lower respiratory disease, primarily chronic obstructive pulmonary disease (COPD), was the fourth leading cause of death in the United States.

And more than half of people with COPD don’t even know they have this potentially life-threatening condition.

There are two main forms of COPD: Chronic bronchitis and emphysema.

These conditions have similar symptoms, and many people with COPD actually have both. But they’re not the same.

If you experience chronic symptoms like frequent coughing or wheezing, shortness of breath, or difficulty breathing, understanding the differences between chronic bronchitis and emphysema, as well as the impacts of COPD, may help you to get the care that you need.

In this article, I’ll explain what COPD is, and the differences in symptoms and causes of chronic bronchitis and emphysema.

I’ll also talk about how each is diagnosed and treated.

Finally, I’ll tell you when you should talk to a doctor.

What is COPD?

Chronic obstructive pulmonary disease (COPD) refers to a group of chronic diseases that cause breathing-related problems.

The airways of people with COPD become partially blocked, making it harder for air to get in and out of their lungs.

COPD is a progressive lung disease that gets worse over time.

Though there are times when symptoms worsen or ease, they never reverse entirely.

The most common cause of COPD is smoking, but not everyone who suffers from COPD was a smoker.

People can also develop COPD from environmental factors—being exposed to secondhand smoke for a long period of time, working or living in places with pollution or certain gases or fumes, or working around a cooking fire that’s not well-ventilated. 

As a result of the inflammation in their airways, people with COPD experience shortness of breath (particularly during physical activity), chest tightness, chronic cough, a lack of energy, and potentially swelling in the legs and arms.

Patients with COPD are also at a higher risk for developing pneumonia and other respiratory infections. 

People with the condition often complain of shortness of breath, particularly with physical activity.

They also suffer from chronic coughing fits and regular respiratory tract infections.

Until recently, COPD was believed to predominantly affect men.

But recent data shows that women are more likely to suffer from COPD.

Since 2000, more women have died from COPD complications than men in the US. 

Other groups at higher risk of developing COPD include:

• Current or former smokers
• People over 65
• Indigenous/American Indians and Alaska Natives 
• Multiracial non-Hispanics
• People who have had lung infections in the past
• People with a history of asthma

If caught early, medication and lifestyle changes can help to delay the progression of COPD.

For example, quitting smoking can have a positive impact after a COPD diagnosis, especially chronic bronchitis. Data shows that about 90% of COPD cases are related to smoking.

Unfortunately, COPD can have a significant effect on quality of life. These effects can include:

• Activity limitations
• Special equipment requirements, like oxygen tanks
• Inability to work
• Confusion or memory loss
• Depression and other mental health conditions
• Increased hospital or urgent care visits 
• Disrupted social life

Symptoms

Symptoms Chronic Bronchitis and Emphysema Have in Common

Chronic bronchitis and emphysema can cause similar symptoms, including:

• Frequent coughing or wheezing
• Chest tightness or pain
• Shortness of breath, especially with physical activity
• Wheezing
• A whistling or squeaking sound when breathing

In rare and severe cases, both can also cause:

• Weight loss
• Weakness, especially in muscles in the lower body
• Swelling of the ankles feet or legs
• Fatigue
• Decreased mental alertness

Chronic Bronchitis Symptoms

Bronchitis occurs when the bronchial tubes become inflamed.

These tubes are part of the lower respiratory tract, which carries air to your lungs.

When the lining of the bronchial tube becomes irritated and inflamed, it generates excess mucus in the lungs.

Acute bronchitis can be the result of having a cold or flu, and the infection traveling down through your throat—also called a chest cold.

But chronic bronchitis is a recurring illness that can last anywhere from two months to two years.

In severe cases, patients may battle chronic bronchitis annually. 

Additional symptoms that can appear with chronic bronchitis include:  

• Slight fever
• Chills
• Excess mucus production

With chronic bronchitis, some people experience symptoms that come and go.

In many cases, symptoms can be triggered by irritants or environmental factors.

Emphysema Symptoms

Your lungs are filled with air sacs—more than 450 million tiny sacs that pick up the oxygen from the air you breathe, and expel carbon dioxide.

These sacs are normally elastic and stretchy, but emphysema causes many of them to become floppy, and destroys the walls of others—so you have fewer air sacs, and they’re less able to do their job.

This makes it harder to breathe.

In addition to the symptoms it shares with chronic bronchitis, in rare and severe cases, emphysema can also cause:

• Lips or fingernails that turn blue or gray with exertion

In many cases, emphysema symptoms may not appear until 50% or more of the lung tissue has already been destroyed.

Causes

Both chronic bronchitis and emphysema can develop after many years of smoking cigarettes.

Apart from smoking, the most common cause of chronic bronchitis and emphysema is long-term exposure to environmental or inhaled irritants, including irritants present at certain job sites, like chemical fumes, dust, and pollution.

In rare cases, they can also both be caused by a genetic condition called alpha-1 antitrypsin deficiency, a protein that protects elastic structures in the lungs.

Chronic bronchitis

Apart from smoking, the most common cause of chronic bronchitis is long-term exposure to irritants.

People at a higher risk of developing chronic bronchitis include:

• Cigarette smokers
• People with compromised immune systems (including infants, young children, and the elderly)
• People who have work in close exposure to chemical irritants
• People who have acid reflux

Emphysema

Smoking and long-term exposure to irritants are also the primary causes of emphysema.

Unfortunately, the symptoms are irreversible.

How is Chronic Bronchitis Diagnosed?

A physical exam and medical history are both involved in diagnosing bronchitis and emphysema.

But there are some additional methods that can be used to provide an accurate diagnosis for each.

With chronic bronchitis, a diagnosis is often given after the patient experiences several cases of acute bronchitis. Additional testing may be used, including:

• Chest X-ray
• CT scan
• Sample of phlegm, also known as sputum culture
• Pulmonary function testing (PFT), used to measure the volume and airflow of air in the lungs
• Pulse oximetry, used to measure the level of blood oxygen
• High resolution computed tomography (HRCT), a scan that can take high-resolution images of the lungs

How is Emphysema Diagnosed?

In addition to a review of a patient’s medical history and physical examination, some of these tests may be conducted:

• Lung function tests, such as peak flow test and spirometry
• Chest X-rays and CT scans
• Blood tests

Treatment

There are no cures for emphysema or chronic bronchitis.

But there are some treatments that can help relieve symptoms, improve your ability to stay active, and slow progression of the disease.

Chronic Bronchitis

Treatment of chronic bronchitis may include:

• Lifestyle changes: Quitting smoking, avoiding secondhand smoke, eating a nutritious diet, and exercising when possible can all help improve chronic bronchitis symptoms and recurrence. Talk to your provider about the safest way to incorporate exercise into your routine to help strengthen your lungs.

• Pulmonary rehabilitation: This is a breathing exercise program guided by a respiratory therapist.

• Oxygen therapy: This is an effective in-home or hospital treatment option for people with low levels of oxygen in their blood. In this treatment, oxygen can be delivered through oxygen concentrators, oxygen-gas cylinders, and liquid-oxygen devices.

• Medication: Your doctor may recommend bronchodilators to help open narrowed passages in your lungs.

• Lung transplant: In severe cases, your doctor may recommend a lung transplant.

Emphysema

Because emphysema is a chronic condition, treatment is often an ongoing process and can include:

• Lifestyle changes: Quitting smoking, avoiding secondhand smoke, eating a nutritious diet, and exercising when possible can all help improve chronic bronchitis symptoms and recurrence. Talk to your provider about the safest way to incorporate exercise into your routine to help strengthen your lungs.

• Pulmonary rehabilitation: This is a breathing exercise program guided by a respiratory therapist.

• Oxygen therapy: This is an effective in-home or hospital treatment option for people with low levels of oxygen in their blood. In this treatment, oxygen can be delivered through oxygen concentrators, oxygen-gas cylinders, and liquid-oxygen devices.

• Medication: Your doctor may recommend bronchodilators, inhaled steroids, or antibiotics.

• Surgery: In severe cases, your doctor may recommend removing damaged lung tissue or a lung transplant.

With both conditions, the right treatment plan will depend on your age, your condition, and the severity of your symptoms.

Could It Be Something Else?            

Even if you’re experiencing a frequent cough, wheezing, or pain and tightness in the chest, it doesn’t necessarily mean that you have chronic bronchitis, emphysema, or even COPD.

Speaking with your provider can help you determine the exact cause of your symptoms.

In some cases, your symptoms may be a sign of another condition, like: 

• Asthma 
• COVID-19
• Lung cancer
• Pulmonary embolism
• Collapsed lung
• Heart problems

When to See a Doctor

If you’re experiencing symptoms that you think could be bronchitis or emphysema, reach out to your provider for care.

Seeking treatment as soon as possible can help to increase your quality of life.

And if you’re a smoker, talk to your doctor about how to quit.

Quitting smoking can help slow the progression of both diseases and improve your overall lung health.

How K Health Can Help

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