Emphysema vs. COPD: What Is the Difference?

Medically Reviewed By Fred Aleskerov, MD
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Chronic obstructive pulmonary disease (COPD) is a progressive airway disease. It is a term that covers two conditions: chronic bronchitis and emphysema. In chronic bronchitis, irritated and inflamed airways constantly produce thick mucus.

In emphysema, there is damage to the air sacs of the lungs.

Most people with COPD have chronic bronchitis and emphysema. However, one can predominate, and this varies from person to person.

This article presents information on emphysema vs. COPD. It explains how emphysema is one of two diseases that make up COPD.

What is COPD?

Senior woman wearing oxygen mask petting her dog in chair
Lucia Romero Herranz/EyeEm/Getty Images

COPD is a lung disease. It makes it hard to breathe. It is chronic, meaning it is always present. It is obstructive, meaning it blocks the movement of air in and out of the lungs. It is also progressive, meaning it gets worse with time. 

In COPD, your body cannot effectively exchange carbon dioxide and oxygen. The body’s tissues cannot get enough fresh oxygen. Carbon dioxide builds up as waste gas in the blood.

As the disease gets worse, this makes it hard to be active. Declining lung function can eventually cause breathing problems even at rest.

There are two components of COPD: chronic bronchitis and emphysema. While some people refer to these conditions as separate diseases, most people with COPD have both. However, one of them may be more serious than the other.

In the United States, COPD is common. It affects about 16 million people in the U.S. It is the third most common cause of death.

What is emphysema?

Emphysema is one of the two conditions that make up COPD. It is the result of damage to the alveoli, which are the tiny air sacs that exchange oxygen and carbon dioxide. In a normal lung, these sacs are like balloons. They expand to fill with fresh air and deflate to push out old air. 

In emphysema, swelling damages the walls of the alveoli. They lose their elasticity. It can also destroy the walls of the alveoli, allowing many alveoli to combine into larger sacs. Both of these effects make it harder for the lungs to exchange gases and move air. 

What are the symptoms of emphysema and COPD?

At first, COPD symptoms can be mild. In fact, you can have COPD without any symptoms in the beginning. However, symptoms will develop and worsen as the disease progresses. Symptoms can also worsen suddenly in flare-ups.

There are several things that can trigger a flare-up, such as a cold or poor air quality.

Symptoms of COPD and their seriousness can vary from person to person. Common symptoms include:

These symptoms can make you feel tired and unable to do activities. As the disease progresses, more symptoms can develop. These include

What are the causes of emphysema and COPD?

In the U.S., cigarette smoking is the most common cause of COPD and emphysema. It accounts for up to 90% of cases.

Smoke and the thousands of chemicals it contains irritates and inflames the airways. This leads to the damage that causes COPD. Smoking increases the chances of getting COPD by up to 25%.

However, not all smokers will develop COPD.

Conversely, not everyone who has COPD smokes. A small number of emphysema cases are due a rare genetic condition, alpha-1 deficiency. This inherited disorder causes a lack of a protein that protects the lungs.

Other possible COPD causes include chronic exposure to secondhand smoke, air pollution, and work-related chemicals, dust, and fumes.

How are emphysema and COPD diagnosed?

To diagnose COPD and emphysema, your doctor will go over your symptoms and medical history. However, it is possible to have COPD and not have symptoms. If you smoke or used to smoke, it is important to talk with your doctor about COPD. Simple testing can tell your doctor about your lung function.

Spirometry is the main test for diagnosing COPD. It can reveal a problem before symptoms appear. The test measures how much and how fast you blow out air. Your doctor may also order the following additional tests:

There is also a blood test to check for alpha-1 deficiency.

What are the treatments for emphysema and COPD?

There is no cure for COPD and emphysema. For most people, the most important step to take to treat COPD and emphysema is to quit smoking. Quitting will remove the source of irritation and inflammation. This can help slow the progression of COPD.

To treat the symptoms of COPD and emphysema, doctors prescribe quick-relief drugs and maintenance drugs. You use maintenance drugs on a regular basis to prevent flare-ups and control symptoms. You use quick-relief drugs short-term when symptoms are worsening.

Maintenance COPD drugs include:

  • inhaled corticosteroids, such as beclomethasone (Beclovent, QVAR)
  • inhaled long-acting beta agonists, such as salmeterol (Serevent)
  • inhaled long-acting muscarinic antagonists, such as tiotropium (Spiriva)
  • oral PDE4 inhibitors, such as roflumilast (Daliresp)

There are also many combination products that have more than one maintenance drug in one inhaler.

Quick-acting COPD drugs include:

  • short-acting anticholinergics, such as ipratropium (Atrovent, Atrovent HFA)
  • short-acting beta agonists, such as albuterol (Accuneb, Proventil HFA, Ventolin HFA, and others)

Pulmonary rehabilitation can help you build strength and endurance for daily activities. Supplemental oxygen may also be helpful.

How can you prevent emphysema and COPD?

COPD, including emphysema, is a highly preventable disease. You can prevent it by not smoking.

If you do smoke, quitting will stop the progressive damage to your lungs. However, quitting cannot reverse any damage that has already happened. Still, it will improve your lung function, improve symptoms of COPD, and slow the progress of COPD.

Frequently asked questions

What is the difference between COPD, emphysema, and chronic bronchitis?

COPD is a term that includes two conditions: emphysema and chronic bronchitis. Most people with COPD have aspects of both conditions. Emphysema affects the air sacs and chronic bronchitis affects the lining of the airways.

Which is worse to have: emphysema or COPD?

Having emphysema means you have COPD. The severity of the symptoms varies from person to person.

What is asthma compared with emphysema and COPD?

Asthma and COPD are two different conditions, but it is possible to have both. This is called asthma-COPD overlap.

Asthma is an airway disease that involves swelling and constriction as a reaction to triggers, such as allergens. While COPD is constant and worsens with time, asthma symptoms are reversible and often have symptom-free periods. 

Summary

“COPD” is a term that includes chronic bronchitis and emphysema. Most people with COPD have symptoms of both.

Emphysema mainly causes shortness of breath. Chronic bronchitis most often causes a cough, which may produce thick mucus.

Smoking cigarettes is the cause of COPD in the majority of cases. Although it is not curable, COPD is preventable and treatable.

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Medical Reviewer: Fred Aleskerov, MD
Last Review Date: 2022 Apr 27
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