Knowing the Difference Between Chronic Bronchitis and Emphysema

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 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.


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