Emphysema vs. Chronic Bronchitis

Medically Reviewed by Poonam Sachdev on December 27, 2023
6 min read

Emphysema and chronic bronchitis are both chronic obstructive pulmonary diseases (COPD) -- long-term conditions that get in the way of airflow and make it hard for you to breathe in and out.

You can have both conditions or just one. The usual cause -- years of cigarette smoking or breathing in a lot of irritating substances such as coal dust, chemical pollution, or smog. In rare cases, a genetic condition can cause emphysema in early adulthood. 

You might have COPD without knowing it. While only 15%-20% of smokers are diagnosed with COPD, experts believe the majority of smokers develop airflow problems.


Emphysema vs. Chronic Bronchitis:

Emphysema and chronic bronchitis aren't the same things. They affect different parts of your airways, producing different symptoms.

Emphysema symptoms start when the walls of tiny air sacs (alveoli) in the lungs become damaged, so less air gets in and out of the lungs. This results in low oxygen levels and makes you feel tired and short of breath.

With chronic bronchitis, the tubes that carry air to and from the lungs are inflamed and produce a lot of mucus. The mucus and inflammation can cause these airways to narrow, making it hard to breathe. Over time, the airway lining can get thicker. These changes cause an irritating, mucus-producing cough, poor airflow, and lung scarring. The damaged airways also act as breeding places for bacterial infections, such as pneumonia.

When your bronchial tubes, which carry air to and from your lungs, get inflamed or irritated, you can develop symptoms of chronic bronchitis. These include:

  • A cough that lasts at least 3 months
  • Coughing up thick mucus that can be clear, yellow, green, or blood-tinged 
  • Feeling tired
  • Feeling short of breath

Bronchitis can be temporary (your doctor may call it “acute”). But if you’ve had the symptoms of bronchitis off and on for at least 2 years, your bronchitis is considered chronic and a form of COPD.

In some cases, chronic bronchitis causes your airways to narrow, making it especially hard to breathe. This is chronic obstructive bronchitis.

When the air sacs in your lungs are damaged, that’s emphysema. The walls of the damaged air sacs can weaken or break. That makes more space for air in your lungs. While that may sound like a good thing, your lungs have less space to pull in oxygen. As a result, less of it goes to your bloodstream, which can make you tired and cause other problems.

Also, damaged air sacs don’t work well. They can trap old air, making it hard for you to take in new air with fresh oxygen.

The main sign of emphysema is shortness of breath. At first, you may have it only when you walk, climb stairs, or engage in other physical activities. Over time though, emphysema can make it hard to breathe even when you’re at rest.

You can’t undo damage to your alveoli. That’s why emphysema usually becomes worse over time.

Most people with emphysema have chronic bronchitis, too.

Cigarette smoke is the biggest cause of COPD, whether it involves emphysema, chronic bronchitis, or both. About three-quarters of people with COPD are current or former smokers. Secondhand smoke can contribute to COPD as well.

Smog, dust, and other pollutants, such as chemical fumes, also can cause emphysema and chronic bronchitis.

Chronic gastric reflux, which irritates your throat with backed-up stomach acid, can contribute to chronic bronchitis, but not emphysema.

In rare cases, emphysema can be caused by a genetic condition called alpha-1-antitrypsin deficiency. This is when your body doesn’t make enough of the protein that helps your lungs work.

Other risk factors

You are more likely to develop COPD if you are:

  • Over 40 (the risk increases with age)
  • Have asthma
  • Have underdeveloped lungs

In addition, studies suggest that women who smoke are more likely to develop COPD and get more severe symptoms than men who smoke. Smaller airways and hormonal differences may play roles.


The same tests are used to spot chronic bronchitis and emphysema. If you have regular breathing problems, your doctor may recommend a:

  • Health history
  • Physical exam
  • Pulmonary function test (PFT), to see how much air your lungs can hold and how much air you can exhale
  • Sputum exam, where your doctor will send a mix of saliva and mucus to a lab to examine the cells in it
  • Chest X-rays or chest CT scans

If your doctor thinks you have emphysema, they might order a blood test that can show them how well your lungs move oxygen and carbon dioxide in and out of your bloodstream.

To treat chronic bronchitis, your doctor may recommend:

  • An inhaled steroid to lower inflammation
  • Bronchodilators, medicines that usually come in inhalers and ease coughing and shortness of breath
  • Antibiotics (if you have a bacterial infection such as pneumonia)
  • Pulmonary rehabilitation, where you learn techniques to help you breathe more effectively

Emphysema can’t be cured. But some treatments can help you breathe easier. Your doctor may recommend:

  • Bronchodilators
  • Inhaled steroids
  • Antibiotics (if you have a bacterial infection)
  • Pulmonary rehabilitation
  • Supplemental oxygen
  • Surgery to remove some of the diseased lung tissue or, in rare cases, damaged air sacs

You may also get nutrition therapy. A dietitian can give you advice on getting to a healthy weight, which can make it easier to breathe. If you have advanced emphysema, you may have a hard time eating enough, so a dietitian may give you tips to help you gain weight.

Colds are respiratory illnesses caused by viruses. They mainly affect your nose and throat, which doctors call your upper airways. But sometimes they affect your lower airways, making COPD worse. Colds and other viral infections are the leading cause of COPD symptom flare-ups.

Catching a cold virus along with COPD can cause:

  • More mucus production
  • Thicker, stickier mucus
  • A change in mucus color
  • Bloody mucus
  • Worsening shortness of breath, cough, or wheezing
  • Trouble sleeping because of cough and breathing problems
  • More tiredness
  • Feeling sicker overall

Why should I take colds seriously with chronic bronchitis or emphysema?

Even though colds are caused by viruses, they increase the chance that you’ll get bacterial infections, including pneumonia in your lungs. Some respiratory viruses that might be mistaken for colds, including those that cause COVID-19, the flu, and RSV, can directly cause pneumonia.

If you get worse when you catch a virus, you might need to spend some time in the hospital. Treatment may include inhaled medications, oxygen, and antibiotics to treat any bacterial infection. Antibiotics do not treat viruses.

To avoid more serious problems with emphysema and chronic bronchitis, it's important to always alert your doctor if your cold symptoms get worse. Don't wait until you have more serious breathing problems to contact your doctor.

The most important thing you can do to prevent chronic bronchitis and emphysema is not smoking. Smoking cessation programs can help if you'd like to quit.

You also can lower your risks by avoiding air polluted with dust, smoke, gases, or fumes.

If you already have COPD, you can lower your risk for infections, airway irritation, and complications by:

  • Washing your hands before eating, cooking, or taking medications, including your breathing treatments.
  • Washing your hands after coughing or sneezing, using the bathroom, attending a social gathering, or spending time with someone who has cold or flu symptoms.
  • Staying up to date with vaccines for COVID-19, flu, pneumococcal disease, and others recommended by your doctor.
  • Keeping a clean house to lower your exposure to dust and mold.
  • Staying away from smoke, including other people's cigarette smoke, as well as car exhaust, factory fumes, and pollen.
  • Using a well-maintained vent to draw cooking fumes out of your house.
  • Properly cleaning breathing equipment, such as inhalers.
  • Eatinga balanced diet. Talk to a health care provider trained in nutrition to make good choices.
  • Drinkingplenty of fluids. Aim for at least six to eight 8-ounce glasses a day.
  • Gettingenough sleep. If you have COPD, you have an increased risk for sleep disorders, so talk to your doctor if you aren't getting restful sleep.

The outlook for COPD differs from person to person.

If you have mild emphysema, there's no cure, but quitting smoking and getting good medical care can help you live with fewer symptoms. With well-controlled emphysema, you can have a normal life span. 

People with more severe emphysema can have a lot of trouble breathing and need frequent medical care. But quitting smoking still helps.

If you keep smoking with emphysema, it can take 10 years off your life. 

If you have chronic bronchitis, it's also unlikely to be cured. But treatment can make you feel better and may keep you from getting any worse.