Understanding COPD

Emphysema and chronic bronchitis are both long-term lung conditions.

They’re part of a disorder known as chronic obstructive pulmonary disease (COPD). Because many people have both emphysema and chronic bronchitis, the umbrella term COPD is often used during diagnosis.

Both conditions have similar symptoms and are typically caused by smoking. Approximately 90 percent of COPD cases are related to smoking. Less common causes include genetic conditions, air pollution, exposure to toxic gases or fumes, and dust.

Keep reading to learn about the symptoms of emphysema and chronic bronchitis, and how they’re diagnosed.

Both emphysema and chronic bronchitis affect your lungs. That means they can cause similar symptoms.

Here are the symptoms they have in common, and how you can tell the difference between these similarities.

Shortness of breath

Emphysema’s primary and almost sole symptom is shortness of breath. It may start small: For example, you might have difficulty breathing after a long walk. But over time, the shortness of breath worsens.

Before long, you may have difficulty breathing even when you’re sitting and haven’t been active.

Shortness of breath isn’t as common in people with bronchitis, but it’s a possibility. As your chronic cough and airway swelling from chronic inflammation worsens, catching your breath may be more difficult.


As breathing becomes more labored, people with emphysema may find that they tire more easily and have less energy. The same is true for people with chronic bronchitis.

If your lungs can’t properly inflate and supply oxygen to your blood, your body will have less energy. Likewise, if your lungs can’t properly expel oxygen-depleted air from your lungs, you have less space for the oxygen-rich air. This can lead you to feel fatigued or weak overall.

SymptomEmphysemaChronic bronchitis
shortness of breath
difficulty performing tasks
feeling less alert
blue or gray fingernails
excess mucus production
symptoms that come and go

Emphysema is a progressive disease. This means that symptoms of the condition grow worse over time. Even if you quit smoking, you can’t stop your symptoms from worsening. You can, however, slow them.

Although its primary symptoms are difficulty breathing and fatigue, you may go on to experience the following complications:

  • difficulty performing tasks requiring concentration
  • decreased mental alertness
  • blue or gray fingernails, especially after physical activity

These are all signs that emphysema is becoming more serious. If you begin noticing these symptoms, be sure to consult your doctor. This can help them make decisions about your treatment plan.

Chronic bronchitis has several more notable symptoms than emphysema. In addition to difficulty breathing and fatigue, chronic bronchitis can cause:

Excess mucus production

If you have chronic bronchitis, your airways produce more mucus than normal. Mucus is naturally present to help catch and remove contaminants.

This condition causes mucus production to kick into overdrive. Too much mucus can clog your airways and make breathing difficult.


A chronic cough is more common in people with chronic bronchitis. That’s because bronchitis creates excess mucus on the lining of your lungs. Your lungs, sensing the irritation caused by extra fluid, try to remove the mucus by causing you to cough.

Because the overproduction of mucus is chronic, or long term, the cough will be chronic, too.


It’s not uncommon to experience a low-grade fever and chills with chronic bronchitis. However, if your fever goes above 100.4°F (38°C), your symptoms may be the result of a different condition.

Fluctuating symptoms

Symptoms of chronic bronchitis may get worse for a period of time. Then they may get better. People with chronic bronchitis may pick up a virus or bacteria that makes the condition worse for a short period of time.

It’s possible, for example, that you can experience both acute (short-term) and chronic bronchitis at the same time.

There isn’t a single test to detect and diagnose emphysema. After assessing your symptoms and reviewing your medical history, your doctor will perform a physical exam.

From there, they may perform one or more diagnostic tests. This may include:

Imaging tests

Both a chest X-ray and CT scan of your lungs can help your doctor detect possible causes for your symptoms.

Alpha-1 antitrypsin (AAT) test

AAT is a protein that protects your lung’s elasticity. You can inherit a gene that will make you AAT deficient. People with this deficiency may be more likely to develop emphysema, even without a history of smoking.

Pulmonary function tests

This series of tests can help your doctor understand how well your lungs are working. They can measure how much air your lungs can hold, how well you’re emptying your lungs, and how well air is flowing into and out of your lungs.

A spirometer, which measures how strong airflow is and estimates your lungs’ size, is frequently used as a first test.

Arterial blood gas test

This blood test helps your doctor get a very precise reading of the pH and the levels of oxygen and carbon dioxide in your blood. These numbers provide a good indication of how well your lungs are working.

Chronic bronchitis is diagnosed after you experience several episodes of acute bronchitis in a short period of time. Acute bronchitis refers to short-term lung inflammation that can affect anyone and is usually the result of a viral or bacterial infection.

Typically, doctors don’t diagnose chronic bronchitis unless you’ve had three or more episodes of bronchitis in one year.

If you’ve had recurrent bronchitis, your doctor may still perform a few tests to determine if you have COPD.

Tests used to diagnose chronic bronchitis include:

Imaging tests

As with emphysema, chest X-rays and CT scans can help your doctor get a better idea of what’s happening in your lungs.

Pulmonary function tests

These tests help your doctor check changes in lung function. A spirometer can measure lung capacity and airflow rate. This may help your doctor identify bronchitis.

Arterial blood gas test

This blood test helps your doctor assess the pH, oxygen, and carbon dioxide levels in your blood. This can help your doctor determine how well your lungs are working.

Several conditions can cause difficulty breathing, chest pain, and shortness of breath. Depending on your individual symptoms, you may not be experiencing emphysema or chronic bronchitis at all.

In some cases, your symptoms may point to asthma. Asthma occurs when your airways become inflamed, narrow, and swell. This can make it difficult to breathe, especially when combined with excess mucus production.

In rare cases, you may actually be experiencing symptoms of:

  • heart problems
  • collapsed lung
  • lung cancer
  • pulmonary embolus

Additionally, it’s not uncommon for people to be diagnosed with both emphysema and chronic bronchitis at the same time. People who have chronic bronchitis may still experience bouts of acute bronchitis on top of their long-term bronchitis issues.

If you’re experiencing any of the symptoms for emphysema or chronic bronchitis, make an appointment to see your doctor.

If you are or were once a smoker, you are at higher risk for developing COPD. It’s important that you get a diagnosis and begin treatment as soon as you can.

Your doctor can determine if your symptoms are the result of emphysema, bronchitis, or another condition. Without treatment, these conditions may worsen and cause additional symptoms and complications.

Emphysema and bronchitis are both lifelong conditions. If you’re diagnosed with either condition, your doctor will work with you to develop a treatment plan focused on symptom management.

If you smoke, quitting is the first step to treating your symptoms. Quitting won’t stop the symptoms, but it may help slow disease progression.