What is the difference between emphysema and COPD?

Medically reviewed by Carmen Pope, BPharm. Last updated on Aug 23, 2022.

The main difference between emphysema and COPD is that emphysema is a progressive lung disease caused by over-inflation of the alveoli (air sacs in the lungs), and COPD (Chronic Obstructive Pulmonary Disease) is an umbrella term used to describe a group of lung conditions (emphysema is one of them) which are characterized by increasing breathlessness. A person with emphysema has COPD; however, not everybody with COPD has emphysema.

What is emphysema?

Emphysema is one of the lung conditions included in the term COPD. Normal lung tissue resembles a sponge; however, the lungs of people with emphysema look like an old used sponge, with large holes in them and a limited ability to “spring-back” into shape.

Emphysema is a progressive disease, that usually starts slowly with small holes between the alveoli, which eventually collapse to form larger air spaces. Old air gets trapped in these air spaces, which makes it difficult for people to inhale fresh air. Blood flow through the alveoli is also impaired meaning that people with emphysema not only struggle to breathe but have trouble receiving enough oxygen.

Cigarette smoking is by far the biggest cause of emphysema, but also the most preventable. Emphysema is more common with age and in males, and it tends to run in families. Other causes include air pollution, airway reactivity, and a deficiency of alpha-1-antitrypsin.

Treatment is with bronchodilator inhalers, which help to open up the airways, corticosteroids to relieve inflammation, and oxygen therapy. Antibiotics are usually also needed regularly as people with emphysema are prone to infections.

What is COPD?

COPD is an umbrella term for three lung conditions that damage the lungs, impair airflow, and make breathing progressively more difficult over time. The three conditions are emphysema, chronic bronchitis, and refractory (non-reversible) asthma. COPD is the third leading cause of death in the U.S. and rates appear to be increasing.

Emphysema is explained above. In chronic bronchitis, the lining of the airways is irritated and inflamed and thickens with mucus. Coughing is frequent and breathing becomes difficult.

In refractory asthma, a severe form of asthma, the airways swell, become narrow and produce extra mucus. Symptoms such as wheezing, coughing, shortness of breath and chest tightness are present most of the time and asthma attacks that do not respond to treatment are frequent. Aggressive treatment, including corticosteroids, is required.

Symptoms of COPD typically include breathlessness, difficulty breathing, increased phlegm, and chest tightness. COPD cannot be cured; however, treatments can improve symptoms and prevent further damage.

Related medical questions

• What is the normal oxygen level for someone with COPD?
• What is the life expectancy of someone with COPD?
• Is Symbicort a steroid inhaler?
• What foods should be avoided with COPD?
• What are the 4 stages of COPD?
• Can severe asthma lead to COPD?
• Prednisone: What are 12 Things You Should Know?
• Why do you not give oxygen to COPD patients?
• Can vitamin C prevent or treat COVID-19 (coronavirus)?
• What is Fluimucil used for?
• How long can you be on Symbicort?

Related support groups

• Chronic Obstructive Pulmonary Disease
  (113 questions, 475 members)
• Bronchitis
  (46 questions, 134 members)

Medical Disclaimer

What is the main cause of pulmonary emphysema?

Return

Pulmonary emphysema is a type of chronic obstructive pulmonary disease (COPD). This disease occurs when the pulmonary alveoli are gradually destroyed, making it increasingly difficult to breathe. When the alveoli are destroyed, a larger space is created, instead of multiple small chambers. This affects the expansion of the lungs and the amount of oxygen that reaches the blood.

What is pulmonary emphysema?

This is a disease that gradually destroys the fibres that make the inside of the lung. The result is that the gas exchange is impaired, and oyxgen does not go into the circulation. Paradoxically, there is more air than normal in emphysematous lungs, but the oxygen fails to be delivered, as the lung is internally destroyed.

Symptoms of pulmonary emphysema

The most common symptom of pulmonary emphysema is shortness of breath, which gradually worsens. The affected person starts avoiding activities that cause shortness of breath in order to relieve the problem. However, the disease worsens to the point that it prevents the person from carrying out daily activities. Emphysema reaches its peak when the person finds it difficult to breathe even when at maximum rest.

What causes pulmonary emphysema?

The main cause of pulmonary emphysema is exposure to airborne irritant, such as those listed below:

• tobacco smoke and marijuana
• air pollution
• manufacturing gases
• silica and coal dust

It can also be caused by an inherited defect, but only in a small number of cases.

Can it be prevented?

The best way of preventing pulmonary emphysema is not to smoke and to avoid passive smoking. It is also advisable to wear a mask if you are in contact with dust or chemical vapours in your workplace. It is recommended to follow the advice below:

• Exercise regularly: Physical exercise can increase lung capacity despite breathing difficulties.
• Protect yourself from cold air: Cold air can cause bronchial spasms, making it difficult to breathe. Wear a scarf over your nose and mouth during the winter to warm the air you inhale.
• Avoid other respiratory infections: Get vaccinated against pneumonia and the flu. Avoiding contact with people with a cold or the flu is also a good preventive measure.

What does treatment involve?

There is no cure for pulmonary emphysema, but some treatments can relieve symptoms and slow the progression of the disease. Treatments can be divided into three groups: medication, therapy, and surgery.

Medication: There are different types of medications that can reduce the severity of the symptoms. Smoking cessation medications are prescribed by a doctor and can help you to stop smoking. Bronchodilators can help alleviate coughing, shortness of breath, and breathing difficulties. Inhaled steroids and bronchodilators can help relieve shortness of breath. Lastly, antibiotics are used if a bacterial infection develops, such as bronchitis or pneumonia.

Therapy: There are two types of therapy: pulmonary rehabilitation and oxygen supplementation that supplements the regular medical treatment with inhalers. The former is a rehabilitation programme that can help reduce the sensation of breathlessness and improve lung capacity. Oxygen supplementation is used with people who suffer from severe emphysema and who have low blood oxygen levels.

Surgery: Similarly, there are two different types of surgery depending on the severity of the emphysema: lung volume reduction and lung transplantation. Lung volume reduction can be achieved either through an operation or, in selected cases, using one-way valves inserted into the affected airways. In the former, surgeons remove small wedges of affected lung tissue. This helps the healthy lung tissue to work more efficiently, and thereby improve breathing. Endobronchial valves also work similarly; they effectively exclude the most diseased part of the lungs and force the air towards the better part. 

Lung transplantation is performed only in young patients if you have severe emphysema and all other treatments have failed.

Emphysema of the lungs. What it is? How to treat?

Breathing ensures the viability and health of our body, which is why diseases of the respiratory system are so dangerous for each of us. There are a lot of diseases of this type, they affect different respiratory organs and affect the body in different ways.

Emphysema occupies a special place in the extensive list, since its development can be caused by
craving for smoking or ordinary bronchitis, which many of us endure more than once.

Emphysema is a chronic disease in which the alveoli (lung tissue elements) are stretched. Because of this, the lung loses its ability to contract, and the process of gas exchange in the body is disturbed: little oxygen enters the blood, and carbon dioxide is poorly excreted.

During this process, excess air appears in the lungs, which does not participate in the process of gas exchange
and interferes with the full functioning of the lungs. At the same time, the walls of the alveoli are gradually destroyed, “air voids” are formed, which leads to the expansion of the chest.

Gradually, the chest becomes barrel-shaped, which most often characterizes patients with emphysema. At the same time, the expanded areas put pressure on the remaining healthy tissue, due to which the ventilation of the lungs is disturbed and the patient develops shortness of breath.

Intrapulmonary pressure rises, the pulmonary arteries are compressed and the load on the right parts of the heart increases, they experience a constant increased load.

Emphysema causes oxygen starvation of tissues and leads to respiratory failure.

Pulmonary emphysema is classified according to three criteria: the nature of the course, origin
and prevalence.

By the nature of the course:

• Acute: may occur due to heavy physical exertion, an attack of bronchial asthma, a foreign object that has entered the bronchial network. Acute emphysema requires emergency treatment.
• Chronic: the lungs change gradually, at an early stage this is reversible and emphysema can be completely cured. Left untreated, it leads to disability.

Origin:

• Primary emphysema: appears due to congenital features of the organism. This is an independent disease, it happens even in newborns and infants. Poorly treatable, rapidly progressing.
• Secondary emphysema: manifested in chronic obstructive pulmonary disease (COPD). In the first stages, it may go unnoticed, gradually the intensification of symptoms affects the patient’s well-being more and more and leads to disability.

If the disease is left untreated, the cavities can occupy entire lobes of the lungs.

By prevalence:

• Diffuse form (diffuse emphysema): the disease affects the entire lung. In severe forms, a donor organ transplant may be necessary.
• Focal form (local emphysema): changes occur only around the foci of other diseases: tuberculosis, scarring, at the site of bronchial obstruction. Symptoms of secondary emphysema are not so pronounced.

Medically speaking, there are a number of causes for emphysema. For example, a change in the properties of a surfactant – a mixture of surfactants lining the alveoli from the inside, or a congenital deficiency of alpha-1-antitrypsin.

For an ordinary patient, all these factors look like riddles, so let’s turn to the everyday part of the question.

One of the main causes of the lungs is called chronic bronchitis and bronchial asthma. If these diseases are not diagnosed in time and treated seriously, then emphysema will become their inevitable result.

The likelihood of developing lung emphysema increases in the presence of the following factors:

• congenital deficiency of α-1 antitrypsin,
• inhalation of tobacco smoke, toxic substances;
• disorders of microcirculation in lung tissues;
• bronchial asthma;
• inflammatory processes in the respiratory bronchi and alveoli;
• professional activity. There is no specific treatment.

Elimination of factors predisposing to emphysema (smoking, inhalation of gases, toxic substances) is paramount.

Main symptoms of pulmonary emphysema:

• shortness of breath;
• cyanosis – a bluish tinge of the skin and mucous membranes;
• an increase in the volume (barrel) of the chest and a decrease in its respiratory movements;
• widening or protrusion of intercostal spaces;
• expansion or protrusion of the supraclavicular areas.

In the early stages of the disease, the main symptom is shortness of breath on exertion. At first it appears infrequently and mainly in winter, but gradually begins to occur at any time of the year, and soon appears with the slightest physical effort and even at rest.

The patient’s inhalation and exhalation change. The first becomes short, as if capturing the air, the second becomes elongated, with closed lips and puffed out cheeks. Since the chest cannot provide normal breathing, the muscles of the chest and neck are connected to the process.

In order to breathe easier, patients often take special positions. For example, sitting with the torso
leaning forward and resting on the knees or the edge of the bed. In this position, the shoulder girdle is fixed and breathing becomes easier.

In especially severe forms, patients develop cyanosis: the tongue, nails and lips become bluish. This is especially noticeable after physical exertion.

Complications can also cause heart and respiratory failure, as well as pneumothorax

Treatment and prevention of emphysema are directly related to the main causes of the disease: smoking and bronchitis.

At the first signs of the disease, and even better before it appears, it is necessary to stop smoking. This is the main method of both prevention and treatment, which at times reduces the risk of developing emphysema or its complication.

If you are ill with bronchitis, then you should not let the treatment take its course. Remember that untreated bronchitis can develop into chronic, and later turn into emphysema.

If you experience severe cough and chest pain, do not try to self-medicate. Be sure to consult a doctor, because he will not only be able to diagnose bronchitis, but also prescribe a treatment that will prevent changes in the lungs.

If your work involves the inhalation of harmful particles such as asbestos, silicon and coal, take care
about lung health, you can either in consultation with a specialist or on your own.

Your doctor can check your current lung condition, prescribe preventive measures such as oxygen therapy, and monitor and respond to even the slightest changes in your respiratory condition.

You yourself can walk more in the fresh air, do not neglect physical activity and strengthen the organs of the respiratory system with the help of gymnastics or breathing exercises.

Surgical treatment consists of an operation to reduce the volume of the lungs. Patients may be eligible for lung transplantation.

As with any serious illness, prevention of emphysema is better than cure. The breathing simulator “Samozdrav” is one of the essential elements of therapy. A distinctive feature of emphysema is the presence of residual air in the lungs, which significantly impairs gas exchange. Excess air in the lungs is not involved in breathing and overstretched lung tissue does not work fully. Which, in turn, is accompanied by a loss of the ability to contract sufficiently and difficult exhalation, as a result of which the supply of oxygen to the blood and the removal of carbon dioxide from it are disturbed. Enrichment of the body with carbon dioxide will improve gas exchange in the lungs, increase the efficiency of blood circulation, gas transport and oxygen release in organs and tissues.

That is why it is extremely important to use the simulator Samozdrav. Enrichment of the body with carbon dioxide will improve gas exchange in the lungs, increase the efficiency of blood circulation, gas transport and oxygen release in organs and tissues. Regular exercises at Samozdrav will contribute to the formation of the correct respiratory rhythm, due to the impact on the respiratory center, which will perform the function of breathing compensation with a reduced functional capacity of the lungs. In addition, a correct breathing rhythm will help relieve shortness of breath and breathing difficulties that are observed in patients with emphysema, especially when exercising and walking. Imitation of physical activity, which is created due to training on the simulator, allows you to train the respiratory muscles.

The most common complications of emphysema are heart failure and pulmonary hypertension. Classes on the simulator “Samozdrav” are a good prevention of cardiovascular diseases for patients suffering from emphysema. In order to prevent and prevent them, it is necessary to use the Samozdrav simulator, which strengthens the vascular wall and allows for normal blood supply and nutrition of the heart muscle.

It is important to start using the simulator even before making a diagnosis. Bronchial asthma and COPD often precede emphysema. However, regular exercise on the simulator allows you to maintain a normal lumen of the bronchi and thus is an effective prevention of emphysema.

Pulmonary emphysema

Pulmonary emphysema is characterized by the destruction of the inner walls of the lung vesicles. Although the mechanism of this process is not fully understood, it is generally assumed that it is the result of a reaction to inflammation caused by foreign particles (for example, toxic substances in tobacco smoke). These particles enter the lungs, after which the immune system releases so-called proteases. These molecules can damage the elastin on the aveolar walls. So-called antiproteases can protect the aveolar walls from destruction. One such antiprotease is alpha-1 antitrypsin. Some people are born with a genetic error that causes not enough alpha-1 antitrypsin to be produced. Such people are especially susceptible to the disease of emphysema.

The elasticity of the lung vesicles is limited and the ability of the lungs to transport air in and out is reduced. Sooner or later, this leads to air retention in the lungs and their swelling (hyperinflation of the lungs). Air lingers in the affected area of ​​the lung and pressure on healthy areas increases and significantly reduces its function.

Another consequence is pressure on the diaphragm, which pushes it down. This leads to a vicious circle, while the first symptoms are shortness of breath and reduced mobility. During the progressive degeneration of the walls of the vesicles of the lungs, the surface on which gas exchange occurs becomes smaller. The consequence of this is an imbalance in gas exchange between the lungs and the blood, which often leads to the symptom of fatigue. Daily activities like climbing stairs can suddenly feel like a lot of work.
Causes of emphysema:
– smoking
– dust
– toxic fumes
– environmental factors
– passive smoking
– alpha-1 antitrypsin deficiency

The main cause of emphysema, as well as lung cancer , is considered smoking .
However, dust, fumes and air pollution can also be responsible for its appearance.

1. Chronic cough and mucus
2. Dyspnea on exertion
3. Fatigue and reduced fitness
4. Persistent dyspnea, reduced quality of life, exacerbations, comorbidities, weight loss
5. Social isolation and depression

Chronic cough, large mucus discharge and shortness of breath on exertion are the first symptoms of chronic obstructive pulmonary disease. If the disease progresses, shortness of breath becomes worse and the patient notices increased fatigue. If gas exchange is severely impaired, comorbidities (such as cardiovascular disease) accumulate and exacerbations become more frequent (sudden shortness of breath or coughing spells), which affects overall health and can lead to social isolation and depression.

As a rule, chronic obstructive pulmonary diseases are detected late, since symptoms appear only in the later stages of the disease. The earlier it is possible to diagnose the disease, the more effective will be the treatment selected by the pulmonologist and the more opportunities to stop or slow down the development of the disease.
There are many methods for diagnosing emphysema. They are also often combined in order to determine the degree of development of the disease and its spread.
The risk group includes long-term smokers, people of middle age and older, suffering from chronic cough, profuse mucous secretions, or with a hereditary predisposition. In these cases, an examination by a pulmonologist is mandatory.

Method	What is being measured?	Why?	Severe emphysema	Short description of procedure
Speedometer	FEV1, VC, FEV1/VC	Measurement of lung capacity, observation of the course of the disease, exclusion of other diseases	FEV1 below 50%	Spirometry is a method for measuring lung function. With it, the volume of the lungs and respiration is measured and depicted graphically on a spirogram.
Body whip smography	residual volume	Determination of the volume of air retained in the lungs to determine the degree of hyperinflation	VR greater than 150% Total lung capacity > 150% indicates severe lung swelling	Body plethysmography can measure lung parameters such as airway resistance, residual lung volume and total lung capacity.
Ventilation scintigraphy	gas diffusion and blood circulation	To determine the area of ​​the lung in which gas exchange is impaired	low level of gas exchange and blood circulation	Radioisotopes are injected or inhaled and a picture is taken with a gamma camera
6-minute walk test	physical activity	Determining exercise capacity for personal training and treatment evaluation	300 meters	Test on a flat surface limited in time, documented by honey. staff
X-ray	X-ray of chest, heart, lungs and diaphragm	To obtain a general view of the chest including the heart, lungs and diaphragms	Dropped diaphragm, chest expansion due to lung swelling	With the help of X-ray diagnostics it is possible to recognize pathological changes
KT	detailed lung slices	Evaluation of the distribution of emphysemic changes in the lungs. Diagnosis of emphysema.	Lung swelling and collapsed veolar sacs	Computed tomography (CT) also uses x-rays, only at different angles, which allows you to create a 3-D image

VC – Vital lung capacity. It is estimated as the difference between the volumes of air in the lungs during full inhalation and full exhalation.
FEV1 – Forced expiratory volume in the first second of the forced expiratory maneuver.
The ratio FEV1/VC , expressed as a percentage – the Tiffno index – is a sensitive index of the presence or absence of deterioration in airway patency. normally 70-75%.

Pulmonary Rehabilitation

Pulmonary Rehabilitation is an individually tailored activity that includes both a physical training program and various educational programs. The patient learns at the same time the correct attitude towards his illness and life without smoking if he is a smoker.

The combination of training and sports for the lungs makes it possible to increase physical performance and promote social contact with other people suffering from this disease. It is very important to continue the exercise even after the end of the rehabilitation course, this can contribute, if not to an improvement in lung function, then at least slow down its deterioration.

The following exercises will help you learn to control your breathing and breathe effectively.

Home Exercises:

Lip Inhibition Breathing:
This breathing can help with shortness of breath by emptying the lungs of the remaining air in them and slowing down the rate of breathing. To perform this exercise, you need to keep your mouth closed and inhale through your nose. When exhaling, keep your lips together slightly and exhale slowly. When the exhaled air is decelerated through the lips, pressure is created due to which the airways remain open, which allows the remaining air to exit the lungs.

Driver seat
This position helps with breathing difficulties by improving the efficiency of the diaphragm.

Respiratory muscle training
This type of training is aimed at strengthening the muscles of the neck and shoulders, which maintains a low diaphragm.

Strength exercises and walks
Exercise improves breathing.

Surgical treatment
A certain group of patients with emphysema is an indication for surgical reduction of lung volume or lung transplantation. Surgery may be an option for patients with severe or very severe emphysema who have not been helped by other treatments.

Lung volume reduction (LVL)
The goal of lung volume reduction (LVL) surgery is usually to remove diseased areas of the upper lobe of the lung. The affected areas of the lung are removed surgically to free up space and relieve pressure on healthy areas. With this procedure, the pressure on the diaphragm is also reduced, which also makes it easier to breathe. The selection of suitable patients and comprehensive preliminary examinations are the basis for good results.

Interventional treatment
Surgery is associated with high risks and the last decades have seen the development of less invasive methods. These methods can be summarized by the concept of bronchoscopic lung volume reduction. There are many methods of bronchoscopic lung volume reduction that can help patients with severe emphysema for whom medical treatment and rehabilitation have not been effective. With this treatment, the removal of a lobe of the lung is not required, the affected area is “turned off” in a controlled manner. This happens by blocking the passage of air into the affected area, compression or influence on the inflammatory process.
The essence of bronchoscopy is the use of a thin, flexible long tube, at the tip of which is a small camera, which allows you to reproduce the image on the screen in live time. A bronchoscope is inserted through the nose or mouth into the lungs.

Application of valves
In Germany, two types of valves are used – endobronchial and intrabronchial. These are so-called one-way valves and are placed in the lungs in order to block the path of air to damaged, swollen areas of the lungs. They are designed in such a way that they remain closed when inhaling, thus preventing the inhaled air from entering the affected area, and open when exhaling, which allows the accumulated fluid and air to be released outside.