What's the Difference Between Chronic Bronchitis and Emphysema?

In 2021, an estimated 14 million adults in the United States reported a diagnosis of chronic obstructive pulmonary disease (COPD) , chronic bronchitis, or emphysema.

If you're not sure what the difference is between the three conditions, that's understandable - you may hear them used interchangeably, although they aren't the same thing. "Both chronic bronchitis and emphysema fall under the more general term COPD," explains David A. Beuther, MD , a pulmonologist at National Jewish Health in Denver. COPD is caused by damage to the airways or other parts of the lung, making it progressively more difficult to breathe. "Oftentimes, most patients have both emphysema and chronic bronchitis, which is why we often just refer to it as COPD," Dr. Beuther adds. About 3 out of 4 cases of COPD are caused by smoking.

And although the treatment for both conditions is similar, the symptoms are not the same. That's because they are due to different types of damage in the lungs.

What Is Chronic Bronchitis?

Chronic bronchitis is long-term inflammation of the bronchial tubes, which are the air passages in the lungs. "People with chronic bronchitis have a persistent cough - usually productive of mucus, not a dry cough," Beuther says. This is also known as "smoker's cough." Although you may have periods where your symptoms are not as bad as others, they won't go away entirely. To have a cough diagnosed by a doctor as chronic, it must be productive (mucus-producing) and last at least three months, multiple times, over the course of two years or longer, Beuther notes.

The primary cause of chronic bronchitis is cigarette smoking. In people who haven't smoked, secondhand smoke, a history of asthma or childhood respiratory infections, or smoke exposure from wood-burning stoves or coal can be contributing factors.

Chronic bronchitis affects around 10 million people in the United States, who are mostly between the ages of 44 and 65.

"The same sort of exposure can lead to a different type of damage to the lung called emphysema," Beuther adds.

What Is Emphysema?

Like chronic bronchitis, emphysema is a chronic condition that develops over time. "Emphysema is predominantly about destruction of the alveoli, the tiny air sacs in the lungs where the oxygen and carbon dioxide are exchanged," says Beuther. "So you can think of chronic bronchitis as the damage that occurs in the bronchial tubes, but if you go farther down, the damage is emphysema, which leads to a different sort of clinical presentation." The damaged air sacs can rupture, leading to trapped air in the lung tissue, which prevents oxygen from moving through your blood as it should. It also makes breathing more difficult.

Most causes of emphysema are the same as chronic bronchitis: primarily smoking, along with a history of respiratory infections and air pollutants. In some cases, emphysema can also be due to a genetic condition called alpha-1 antitrypsin deficiency. Over 3 million people in the U.S. have emphysema, although many more are diagnosed with COPD.

Why Do Chronic Bronchitis and Emphysema Get Confused for Each Other?

Because they so often occur together, it's easy to see how chronic bronchitis and emphysema can be confused. "There certainly are people who don't have any detectable emphysema and just have chronic bronchitis. And there are people who have just emphysema, with no chronic bronchitis," says Beuther. "But they're both conditions related to smoking and you have trouble breathing. And they tend to occur in the same kind of older population of people who have had this exposure." Neither condition is curable, but they are treatable.

The main difference between the two conditions is in their hallmark symptoms: While chronic bronchitis produces a frequent, mucus-filled cough, emphysema causes shortness of breath.

But in people with COPD, the split between chronic bronchitis symptoms and emphysema symptoms tends to vary. "In my experience, people are likely to have more of one than the other. But that's just because very few people are going to end up right in the center of that continuum," says Beuther. "Most patients have clinically significant amounts of both."

What Are the Symptoms of Each Condition?

The symptoms for each condition can have a bit of overlap.

Symptoms of chronic bronchitis include:

• Frequent wet cough
• Coughing spells
• Wheezing
• A whistling sound when you breathe
• Tightness in your chest
• Shortness of breath, especially during exercise

Chronic bronchitis can also put you at greater risk for respiratory infections like colds and flus.

Symptoms of emphysema include:

• Shortness of breath
• Constantly feeling like you're not able to get enough air
• Ongoing fatigue
• Decreased activity level
• Weight loss
• Tightness in your chest

"Emphysema tends to be more about breathlessness and low oxygen. And in people who have predominantly emphysema and very little or no chronic bronchitis as their flavor of COPD, they might not cough or have very little cough and never have bronchitis or chest infections," Beuther says.

Patients with chronic bronchitis are prone to worsening symptoms due to bronchial infection, called exacerbations. These exacerbations can be caused by bacteria or viruses and are characterized by symptoms of increase in cough, increase in sputum volume, and discoloration of sputum.

Symptoms Chronic Bronchitis Emphysema Frequent wet cough X Coughing spells X Wheezing X A whistling sound when you breathe X Tightness in your chest X X Shortness of breath, especially during exercise X X Not able to get enough air X Ongoing fatigue X Decreased activity level X Weight loss X

How Do I Get Properly Diagnosed?

To diagnose chronic bronchitis, your healthcare provider will check if you have a mucus-producing cough, lasting at least three months a year, for at least two years. From there, they can order tests to confirm the diagnosis, including chest X-rays , a CT (computed tomography) scan, or lung function tests like spirometry.

If you or your doctor suspect you have emphysema, your doctor will start by listening to your lungs with a stethoscope. If they hear a hollow sound, it likely means your lungs are trapping air. Then they can order tests to confirm your emphysema diagnosis, including a chest X-ray, a CT scan , spirometry, or an electrocardiogram (EKG) to rule out heart disease. Your doctor may also order a blood test or genetic testing to see if you have alpha-1 antitrypsin deficiency .

Warning Signs

As mentioned, the primary warning sign of chronic bronchitis is a persistent wet cough. The main sign of emphysema is shortness of breath.

Since both conditions are progressive - meaning they worsen over time - make sure to see a doctor if you think you may have one or both of them, especially if you have a history of smoking.

Prevention

Prevention for both conditions is generally the same:

• No smoking
• Quitting smoking , if you smoke
• Avoiding exposure to secondhand smoke
• Avoiding exposure to air pollution, dust, and chemical fumes
• Remaining up to date with vaccinations against influenza, RSV, and pneumococcal pneumonia.

Treatment

Another reason chronic bronchitis and emphysema can be confused is because of how they are treated. "The treatment [for both] is remarkably similar. Number one would be smoking cessation," says Beuther. "Or if you're working at a job where you may be exposed to dust, fumes, chemicals, or air pollution, that you're wearing respiratory protection or avoiding that exposure." Getting a yearly flu shot, COVID vaccine, and RSV vaccine can also help prolong your life, he adds.

Both conditions can also be treated with medications, such as:

• Bronchodilators to relax and open up the muscles in your lung airways
• Inhaled steroids to reduce lung inflammation and mucus production
• Oral steroids to treat symptom flare-ups
• Antibiotics to treat lung infections like pneumonia, and some bronchial infectious exacerbations
• Anti-inflammatory medications to reduce lung inflammation
• Oxygen therapy (supplemental oxygen)

"Exercise and even pulmonary rehabilitation are also important - as important as any medication we can prescribe," Beuther says, because both conditions can lead to muscle weakness. Good nutrition can also help you retain muscle and maintain energy.

Beuther says that in a very small number of people who predominantly have severe emphysema, there is also a surgical option called lung volume reduction surgery (LVRS), which removes diseased tissue to reduce trapped air and help the rest of the lung work better. To qualify, you must be under 75 years old, and the damage has to be primarily in the upper area of your lungs. The surgery is done if other treatments are not enough. The surgery can improve your quality of life, but doesn't affect your life expectancy. There is also an option of achieving a similar result with a lung volume reduction that is done bronchoscopically, inserting valves into the lung.

The Takeaway

Chronic bronchitis and emphysema often occur together. The conditions both fall under the umbrella term of chronic obstructive pulmonary disease (COPD). Chronic bronchitis is due to inflammation of the air passages in the lungs, and the main symptom is a persistent, wet cough. But emphysema is due to damage in the lungs' air sacs, and the main symptom is shortness of breath. The causes, prevention, and treatment for both conditions are largely the same.

Resources We Trust

• American Lung Association: Chronic Bronchitis
• Centers for Disease Control and Prevention: Chronic Obstructive Pulmonary Disease (COPD)
• Cleveland Clinic: Emphysema
• National Heart, Lung, and Blood Institute: What Is COPD?
  

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. Liu Y et al. Trends in the Prevalence of Chronic Obstructive Pulmonary Disease Among Adults Aged ≥18 Years - United States, 2011–2021. Morbidity and Mortality Weekly Report (MMWR) . November 2023.
2. COPD Causes and Risk Factors. American Lung Association . June 7, 2024.
3. Chronic Bronchitis. John Hopkins Medicine .
4. Dotan Y et al. Chronic Bronchitis: Where Are We Now? Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation . March 2019.
5. Emphysema. American Lung Association .
6. Chronic Bronchitis. MedlinePlus . January 2024.
7. Emphysema. Cleveland Clinic . November 2022.
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Michael S. Niederman, MD

Reviewer

Michael S. Niederman, MD, is the lead academic and patient quality officer in the division of pulmonary and critical care medicine at Weill Cornell Medical Center in New York City; a professor of clinical medicine at Weill Cornell Medical College; and Lauder Family Professor in Pulmonary and Critical Care Medicine. He was previously the clinical director and associate chief in the division of pulmonary and critical care medicine at Weill Cornell Medical Center.

His focus is on respiratory infections, especially in critically ill patients, with a particular interest in disease pathogenisis, therapy, and ways to improve patient outcomes. His work related to respiratory tract infections includes mechanisms of airway colonization, the management of community- and hospital-acquired pneumonia, the role of guidelines for pneumonia, and the impact of antibiotic resistance on the management and outcomes of respiratory tract infections.

He obtained his medical degree from Boston University School of Medicine, then completed his training in internal medicine at Northwestern University School of Medicine, before undertaking a pulmonary and critical care fellowship at Yale University School of Medicine. Prior to joining Weill Cornell Medicine, he was a professor in the department of medicine at the State University of New York in Stony Brook and the chair of the department of medicine at Winthrop-University Hospital in Mineola, New York, for 16 years.

Dr. Niederman served as co-chair of the committees that created the American Thoracic Society's 1993 and 2001 guidelines for the treatment of community-acquired pneumonia and the 1996 and 2005 committees that wrote guidelines for the treatment of nosocomial pneumonia. He was a member of the American Thoracic Society/Infectious Diseases Society of America committee that published guidelines for community-acquired pneumonia in 2007. He was also the co-lead author of the 2017 guidelines on nosocomial pneumonia, written on behalf of the European Respiratory Society and the European Society of Intensive Care Medicine.

He has published over 400 peer-reviewed or review articles, and has lectured widely, both nationally and internationally. He was editor-in-chief of Clinical Pulmonary Medicine , is an associate editor of Critical Care and the European Respiratory Review, and serves on the editorial boards of Critical Care Medicine and Intensive Care Medicine . He has previously served on the editorial boards of the American Journal of Respiratory and Critical Care Medicine and Chest. For six years, he was a member of the Board of Regents of the American College of Chest Physicians, and in 2013, he was elected as a master of the American College of Physicians.

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Erica Patino

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Erica Patino is a freelance writer and editor, content strategist, and usability specialist who has worked for a variety of online health outlets, including Healthline, Sharecare, and Twill Care. She was previously a senior editor at Everyday Health. She is also the founder and editor-in-chief of Hear 2 Tell, a website that covers advances in hearing loss treatment. Patino lives in Portland, Oregon, with her husband and twin sons. … See full bio See Our Editorial Policy Meet Our Health Expert Network