Confused About COPD and Emphysema? Here's What You Need to Know

Chronic obstructive pulmonary disease (COPD) is an overarching term, and it includes two lung conditions: emphysema and chronic bronchitis . Emphysema is a type of COPD, and that's why if you have emphysema, your doctor may also say you have COPD.

"Emphysema is usually a description of images - CT scan or X-ray - and is only one part of the disease of COPD," says Uddalak Majumdar, MD , pulmonologist at the Cleveland Clinic in Ohio.

What Is COPD?

COPD is primarily caused by long-term exposure to irritants such as cigarette smoke, air pollution, or occupational hazards like dust and chemicals. COPD affects an estimated 16 million Americans and is the third leading cause of death in the United States.

When a person has COPD, they have persistent obstructed airflow through the lungs, and it can gradually get worse and make it harder and harder to breathe.

What Is Emphysema?

When you inhale, air containing oxygen enters your windpipe, travels through the large and small airways (called bronchi and bronchioles), and ends up in numerous air sacs in the lungs (called alveoli).

Emphysema is when the walls of those air sacs are destroyed, says MeiLan King Han, MD , professor of medicine and chief of pulmonary and critical care at the University of Michigan Health in Ann Arbor.

Damage to both the bronchioles and the alveoli cause air to be trapped in the lungs, making it harder to fully breathe in and out.

Out of the estimated 16 million people who have COPD, 3 million have emphysema.

The top risk factor for the disease is smoking, although long-term exposure to air pollutants or genetic factors, such as alpha-1 antitrypsin deficiency, can also contribute.
The most common genetic form of emphysema, alpha-1 antitrypsin deficiency is an inherited condition that affects the body's ability to produce a protein (alpha-1) that protects the lungs. It can only be diagnosed by using a blood test.

Why Do COPD and Emphysema Get Confused for the Other?

Emphysema and COPD are sometimes used interchangeably, but they each have a different meaning. Emphysema is a type of COPD, so a person with emphysema could have COPD; however, not everyone with COPD has emphysema.

What Are the Symptoms of COPD and Emphysema?

The main symptoms of COPD include the following:

• Chronic cough (that may bring up mucus or phlegm)
• Difficulty with walking, bathing, dressing, or eating because of fatigue or shortness of breath that gets worse with activity
• Wheezing
• Chest tightness
• Frequent respiratory infections like acute bronchitis or pneumonia

Emphysema also has the symptoms listed above and some additional ones:

• Wheezing
• Sharp chest pain
• Quick, shallow breathing
• Swollen feet, ankles, or legs
• Bluish or purple tint to the lips, toes, or fingernails (in severe cases)
• Frequent nighttime awakenings
• Weight loss

How Do I Get Properly Diagnosed?

Typically, healthcare providers use a holistic approach when diagnosing COPD, says Dr. Majumdar.

To start, they will review your medical history and conduct a physical exam, followed by lung function testing, typically spirometry.

Spirometry is a test to measure the amount and speed of air that a person can blow into a mouthpiece.

Other initial tests can include the following:

• An additional spirometry after using a bronchodilator (medications used to dilate the bronchial tubes)
• Body plethysmography to measure the amount of air a person can inhale and to test for the presence and amount of air that remains trapped in the lungs
• Lung diffusion capacity test, which measures how well your lungs deliver oxygen to your blood from the air you breathe
• Chest X-rays or CT scans to show details of the airway and airway walls
• Mucus (sputum) culture to test for the presence of an infection

The condition is best assessed with CT scans and X-ray, says Majumdar.

"People with severe emphysema usually have an enlarged chest, due to trapped air in the lung, often with a little hunch and shoulders drawn high, and they breathe shallowly," he says. The body tries to compensate for the lack of oxygen by breathing faster, which can give patients a pinkish hue, he says.

Warning Signs

Many of the early warning signs of COPD and emphysema are the same, including coughing, shortness of breath, wheezing, and fatigue.

If you aren't sure if your symptoms are COPD and you haven't been diagnosed, you should first ask your doctor for a breathing test, like spirometry, says Dr. Han.

Prevention

The most common risk factor for COPD and emphysema in the United States is tobacco smoke exposure, but occupational exposure may contribute, says Han.

Occupational exposure includes potentially harmful exposure to hazardous chemicals at work. Certain jobs - like working in construction, a factory, or a garage, or as a firefighter - put people at risk for COPD because of the quality of air they breathe.

Hundreds of studies show that quitting smoking is the single most effective measure to reduce the risk of developing these conditions.

The chemicals in cigarette smoke weaken your lungs' defense against infections, narrow air passages, cause swelling in air tubes, and destroy air sacs.

Treatment

While there is no cure for COPD and emphysema, treatments can help alleviate symptoms, improve lung function, and slow disease progression. Because emphysema is a type of COPD, the recommended treatments are the same.

Common treatments include these options:

Lifestyle Changes Stopping smoking is the first step in treating COPD and emphysema.

Medications Depending on the severity of COPD or emphysema, medications may include bronchodilators, which relax the muscles around the airways to help make breathing easier, and inhaled steroids, which can reduce inflammation or swelling in the airways.

Pulmonary Rehabilitation This health program includes exercise training, breathing exercises, and education on managing the condition.

Oxygen Therapy Supplemental oxygen can improve oxygen levels in the blood.

Surgical Interventions Lung volume reduction surgery removes the area of the lung most affected by the disease so the remaining lung functions more efficiently. A lung transplant may be recommended in severe cases.

The Takeaway

While emphysema is a type of COPD, not all COPD cases indicate emphysema. Early detection through lung function testing, especially spirometry, is vital for timely intervention and management. Treatments such as stopping smoking, taking certain medications, and using oxygen therapy can significantly improve quality of life.
Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy . We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

1. Chronic Obstructive Pulmonary Disease (COPD). Centers for Disease Control and Prevention (CDC) . May 15, 2024.
2. Chronic Obstructive Pulmonary Disease (COPD). Cleveland Clinic . May 17, 2022.
3. In Brief: How Do Lungs Work? InformedHealth.org . April 18, 2023.
4. COPD. Mayo Clinic . April 15, 2020.
5. Emphysema. American Lung Association .
6. What Is COPD? National Heart, Lung, and Blood Institute . October 25, 2023.
7. Early Warning Signs of COPD. American Lung Association . June 7, 2024.
8. Emphysema. Cleveland Clinic . November 29, 2022.
9. Ahmad I et al. Occupational Exposure and Respiratory Health of Workers at Small Scale Industries. Saudi Journal of Biological Sciences . January 27, 2020.

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David Mannino, MD

Medical Reviewer

David Mannino, MD, is the chief medical officer at the COPD Foundation . He has a long history of research and engagement in respiratory health.

After completing medical training as a pulmonary care specialist, Dr. Mannino joined the Centers for Disease Control and Prevention (CDC) Air Pollution and Respiratory Health Branch. While at CDC, he helped to develop the National Asthma Program and led efforts on the Surveillance Reports that described the U.S. burden of asthma (1998) and COPD (2002).

After his retirement from CDC in 2004, Mannino joined the faculty at the University of Kentucky, where he was involved both clinically in the College of Medicine and as a teacher, researcher, and administrator in the College of Public Health. He served as professor and chair in the department of preventive medicine and environmental health from 2012 to 2017, with a joint appointment in the department of epidemiology.

In 2004, Mannino helped to launch the COPD Foundation, where he served as a board member from 2004 through 2015, chairman of the Medical and Scientific Advisory Committee from 2010 through 2015, and chief scientific officer from 2015 to 2017.

Mannino has over 350 publications and serves as an associate editor or editorial board member for the following journals: American Journal of Respiratory and Critical Care Medicine , Chest , Thorax , European Respiratory Journal , and the Journal of the COPD Foundation . He was also a coauthor of the Surgeon General's Report on Tobacco in 2008 and 2014.

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Becky Upham has been professionally involved in health and wellness for almost 20 years. She's been a race director, a recruiter for Team in Training for the Leukemia & Lymphoma Society, a salesperson for a major pharmaceutical company, a blogger for Moogfest, a communications manager for Mission Health, a fitness instructor, and a health coach.

She majored in English at the University of North Carolina and has a master's in English writing from Hollins University.

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