Chronic obstructive pulmonary disease (COPD) is a group of diseases that cause damage to the lungs. Emphysema is a type of COPD.

COPD is a group of lower respiratory diseases. These diseases damage the airways and cause chronic inflammation in the lungs, making it difficult for a person to breathe. COPD is a chronic, progressive disease, which means there are treatments for it, but no cure.

The term COPD includes chronic bronchitis and emphysema. A person with emphysema has COPD, but a person with COPD may not necessarily have emphysema.

COPD is the third-leading cause of death in the United States. Smoking is a leading cause of COPD, but exposure to other harmful substances, such as toxic workplace chemicals or pollution, can also lead to COPD.

Keep reading to learn more about what COPD and emphysema are.

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COPD is an umbrella term for progressive lung diseases, emphysema, and chronic bronchitis. These conditions impair lung function and can lead to feelings of breathlessness.

Typically, when a person breathes, air travels into tubes in the lungs that doctors call bronchial tubes, or airways. These tubes split into bronchioles, which are smaller pathways. The bronchioles end in alveoli, or groups of tiny air sacs. Blood capillaries run through the walls of these air sacs.

Typically these bronchioles and alveoli are elastic. Each air sac inflates like a small balloon as the person breathes in and deflates as they breathe out. This allows gas exchange to occur — or the removal of carbon dioxide and the absorption of oxygen.

In COPD, this process does not happen as easily, and less air flows through the airways. This is because of chronic inflammation and damage to the airways.

In bronchitis, tissue in the bronchial tubes can swell and thicken. Mucus may also build up and clog these airways. In emphysema, inflammation targets the air sacs of the lungs, while in chronic bronchitis, the inflammation is primarily in the bronchial tubes. Some people with COPD have both conditions.

The causes of both COPD and emphysema are similar. In most cases, a history of smoking is the main cause.

Emphysema is a type of COPD. In this condition, damage to the walls of the air sacs affects their ability to exchange gases in the lungs. The inner walls of the sacs can weaken and lose their shape. These walls may break, further undermining the body’s ability to exchange gases.

This reduces the surface area of the lungs so that less oxygen can get into the bloodstream through the capillaries.

Because of the damage to the air sacs, the old air is unable to escape and stays in the lungs. This leaves less room in the air sacs for fresh air to enter, compounding the problem of getting new oxygen to the body.

COPD and emphysema share similar outward symptoms because emphysema is a type of COPD. These symptoms can take time to appear and may only occur after significant damage to the lungs. A doctor cannot diagnose the type of COPD a person has on the basis of symptoms alone.

Typically, a person will notice the first symptoms of COPD or emphysema during physical activity.

A person with one, or both, of these conditions may experience:

Symptoms tend to worsen over time, especially if a person continues their exposure to smoke or other irritants.

The most common causes of all forms of COPD, including emphysema, are environmental. Cigarette smoke is the leading cause of COPD.

Doctors diagnose more cases of COPD in females than in males.

Having asthma is a risk factor for developing COPD, and the two can also overlap. Medical professionals may refer to this as asthma-COPD overlap syndrome.

Environmental factors

In the U.S., the leading cause of COPD and emphysema is tobacco exposure through smoking. The National Heart, Lung, and Blood Institute estimates that up to 70% of people with COPD smoke or used to smoke.

Breathing in secondhand smoke from cigarettes, air pollution, or chemical fumes can also lead to COPD and emphysema.

Genetic factors

People may develop some forms of COPD and emphysema despite never smoking or experiencing long-term exposure to other irritants.

Alpha-1 antitrypsin deficiency (AATD) is a genetic type of emphysema. It causes a person to have low levels of antiproteases, which can lead to protease-related damage in the lungs. This condition can also cause liver damage when a mutated protein accumulates in the liver.

The presence of COPD symptoms should trigger the evaluation for an early diagnosis. This opens access to treatment, which may help improve quality of life. Unfortunately, many people do not receive a diagnosis until they already have severe damage in their lungs.

For diagnosis, a doctor will review the person’s symptoms, family and medical history, and ask about exposure to lung irritants, especially cigarette smoke. To confirm a diagnosis, they may order several tests.

Spirometry test

Medical professionals typically use a spirometry test to confirm a COPD diagnosis.

During a spirometry test, a person blows into a tube connected to a machine that doctors call a spirometer. The machine measures how much air the lungs can hold and how fast the person can blow air from the lungs.

This test can detect lung disease before symptoms start, and it may track the progression of the disease. It can also monitor how well treatment is working.

Other lung function tests

Lung, or pulmonary, function tests, which include spirometry, measure the amount of air that a person inhales and exhales. They also examine the lungs’ ability to deliver enough oxygen to the blood.

Chest X-ray or CT scans

Doctors may use X-ray and computerized tomography (CT) scans to diagnose COPD and emphysema. These imaging tests can also identify other issues such as cancer and pulmonary fibrosis, which is a type of lung scarring.

Blood gas analysis

This blood test measures the amount of oxygen and carbon dioxide in the blood. This can show how well the lungs are performing.

Other blood tests

Blood tests do not diagnose COPD or emphysema but can help to confirm or rule out if other conditions may be causing lung function issues. Importantly, blood tests can diagnose genetic conditions such as AATD.

There is no cure for any form of COPD, including emphysema, but treatment can help to slow the progression of the disease and manage symptoms.

Treatments include medical, surgical, and therapeutic interventions.

Medical treatments

Medical treatments for COPD and emphysema may include inhaled and oral medicines.

Options often include:

  • Bronchodilators: A person inhales these medications. They relax the muscles around the airways, relieving coughs and shortness of breath.
  • Steroids: Taking oral or inhaled steroids can help with lung inflammation.
  • Antibiotics: People with COPD and emphysema are susceptible to lung infections and may need antibiotics to treat bacterial causes of bronchitis or pneumonia.

Pulmonary therapy and rehabilitation

A doctor may also recommend pulmonary therapy and rehabilitation.

As part of a pulmonary rehabilitation program, individuals can learn new ways to improve their breathing and ability to exercise. Therapy aims to improve a person’s quality of life and decrease the frequency and duration of hospital stays.

During this rehabilitation, people can learn:

  • breathing exercises
  • exercise training
  • nutrition counseling
  • education on managing lung conditions

Should a person experience severe lung damage and their oxygen levels remain low, doctors may recommend supplemental oxygen therapy.

This involves a person breathing from an oxygen tank via a mask or nasal prongs. Depending on a person’s oxygen levels, they may need to breathe from these devices continuously or only at certain times of the day.

Surgery

Some people may need surgery to improve their quality of life and to manage the symptoms of the disease.

Options include:

  • Lung transplant: A surgeon replaces the COPD-damaged lungs with healthy lungs from a donor. It is not suitable for everyone, and major risks include organ rejection.
  • Lung volume reduction: This decreases lung volume by removing damaged lung tissue, allowing better gas exchange of oxygen and carbon dioxide.
  • Bullectomy: This involves removing large air spaces, known as bullae, that form in the lungs when the air sacs become damaged. Removing the bullae also helps with the gas exchange of oxygen and carbon dioxide.

Knowing when to seek medical treatment for COPD and emphysema can be difficult as initial symptoms may not be obvious. Anyone who experiences the above symptoms should speak with a doctor promptly.

If a person is already receiving treatment, they will need to seek medical care if any of the following occur:

  • shortness of breath that is worse or more frequent than usual
  • changes to color, amount, or thickness of mucus or sputum
  • mucus or sputum becomes bloody
  • increase in coughing or wheezing
  • swelling of the feet or ankles that does not go away after sleeping with the feet up
  • headaches or dizziness, most frequently in the morning
  • fever, especially when combined with flu-like symptoms
  • unexplained severe weakness
  • confusion or disorientation

A person who experiences any new shortness of breath or breathing difficulty that does not improve with medications should see a doctor.

Smoking is a significant risk factor for COPD. Quitting smoking can reduce the risk of chronic airway damage and all forms of COPD.

Some other steps a person can take to lower their risk include:

  • avoiding secondhand smoke
  • minimizing exposure to workplace toxins by wearing protective gear
  • avoiding polluted areas or going outside during times of high pollution

Managing COPD can improve a person’s quality of life and slow disease progression.

Tips for living with COPD and emphysema include:

  • Quitting smoking: Smoking causes and worsens COPD and emphysema, so it is crucial for a person to stop smoking as soon as possible after a diagnosis.
  • Controlling breathing: A person can use the techniques they learn in pulmonary rehab to manage their shortness of breath.
  • Eating a healthy diet: This helps to maintain strength and boost the immune system.
  • Getting plenty of exercise: Activity improves endurance and increases lung function, which can lessen symptoms. Regular physical activity can also improve mood, strength, and balance.
  • Managing mucus: Clearing mucus from the airways through controlled coughing and hydration can help.
  • Avoiding pollutants: Keeping away from secondhand smoke and staying indoors on days with poor air quality can slow the progression of the disease.

A person with COPD should follow their doctor’s instructions, take all prescribed medications, and see their doctor regularly.

Quitting smoking offers benefits no matter how long a person has smoked. Some people can find quitting to be difficult as they become too reliant on the nicotine in cigarettes. People may want to try the following strategies:

  • To quit as quickly as possible, go “cold turkey” rather than trying to cut down.
  • Make a plan to quit that includes scheduling a quit day, making a list of resources, and coming up with a plan to manage cravings.
  • Treat each moment spent not smoking as an investment. The longer a person can go without smoking, the closer they are to breaking their dependence on nicotine.
  • Use medical treatment to make quitting easier. A person can ask a doctor about drugs to help stop smoking, or about nicotine replacement therapy.
  • Try replacing smoking with a healthier habit, such as exercise.
  • Make a list of a person’s reasons for quitting, then consult it when they have cravings.
  • Treat quitting as a process that requires time and practice. If a person does not quit the first time, they may learn things that make quitting easier next time.
  • For additional support, people may want to try using quitlines, such as 1-800-QUIT-NOW.

E-cigarettes and COPD

Electronic cigarettes, or e-cigarettes, are gadgets that people use to inhale and exhale a vapor-like aerosol. Some people may use this form of taking in nicotine as an alternative to smoking. However, scientists are not fully aware of the longer-term health consequences of electronic cigarettes.

The American Heart Association recommends that people who are trying to quit smoking should avoid e-cigarettes and instead try other proven smoking-cessation methods.

Research suggests that people with COPD should avoid using e-cigarettes as a smoking-cessation method. E-cigarettes have a similar ability to conventional tobacco cigarettes to stimulate inflammation and lung damage.

Chronic bronchitis and emphysema do share some similarities. This can include sharing risk factors, such as family history, treatment methods, and a few others.

For example, both cause similar symptoms, and a person cannot tell which one they have on the basis of symptoms alone. Some potential differences in symptoms include:

  • Illness: People with chronic bronchitis may have symptoms similar to those of a respiratory infection, including chronic cough.
  • Mucus production: Chronic bronchitis affects the bronchial tubes. This can cause excess mucus production that makes a person cough more. The chest or throat may also feel congested.
  • Trouble breathing: While both conditions cause trouble breathing, emphysema directly attacks the sacs that allow gas exchange in the lungs. This may cause more difficulty breathing and symptoms such as blue lips or nails.

COPD refers to a number of lung conditions, and emphysema is one of them.

COPD and emphysema can be life-threatening. It is important for people to recognize the signs and learn how to manage their symptoms.

Stopping smoking and asking others not to smoke nearby can greatly reduce the risk of emphysema and COPD. People who smoke should make a plan to quit and consult a doctor if they need support to stop smoking.