Emphysema vs. COPD: What stage of COPD is emphysema?

Emphysema vs. COPD causes | Prevalence | Symptoms | Diagnosis | Treatments | Risk factors | Prevention | When to see a doctor | FAQs | Resources

Lung disease is a prevalent problem in America today. Emphysema is a type of COPD that causes damage to the alveoli or the tiny air sacs in the lungs. COPD stands for chronic obstructive pulmonary disease and is a lung disease that can limit airflow from the lungs, causing trouble breathing. COPD encompasses various conditions, including emphysema and chronic bronchitis. 

Read on for an overview of emphysema and COPD, including their causes, prevalence, symptoms, risk factors, treatment options, and more. 

Causes

What causes Emphysema

Emphysema is generally caused by long-term exposure to airborne irritants, such as tobacco or marijuana smoke, air pollution, chemical fumes, and dust. In addition, genetic factors such as alpha-1-antitrypsin deficiency may cause emphysema. While smoking is the most common risk factor, the disease can still develop in non-smokers due to factors like secondhand smoke exposure, air pollution, occupational exposure, or genetics.

What causes COPD

COPD is mostly caused by long-term exposure to lung irritants, with tobacco smoke being the biggest offender. Both people who smoke and those around smokers can develop COPD due to this harmful smoke. Environmental factors, like pollution, workplace dust, fumes, and certain chemicals, can also cause COPD by irritating and damaging the lungs over time. Some people are genetically more likely to get COPD due to a condition called alpha-1-antitrypsin deficiency, which affects the body’s ability to protect the lungs. 

Emphysema vs. COPD causes
Emphysema	COPD
Smoking and secondhand smoke Air pollution Chemical fumes Dust Alpha-1-antitrypsin deficiency	Smoking and secondhand smoke Air pollution Chemical fumes Dust Alpha-1-antitrypsin deficiency

Signs and symptoms of emphysema and COPD

Emphysema symptoms

There are various symptoms associated with emphysema, although some individuals may not notice any symptoms when the condition first develops. The main symptom of emphysema is shortness of breath, which occurs gradually and can become more severe over time. Other symptoms may include:

• Long-term cough, often known as a “smoker’s cough”
• Shortness of breath, especially while engaging in light exercise or walking up steps
• Wheezing
• Long-term mucus production
• An ongoing feeling of fatigue

It’s not uncommon for individuals to experience shortness of breath as their only symptom until 50% or more of the lung tissue has been damaged. Consult a doctor or healthcare provider if you experience any of these symptoms.

COPD symptoms

There are various signs and symptoms that indicate COPD in an individual. Like emphysema, symptoms of COPD often don’t appear until there is significant lung damage. These symptoms will generally worsen over time, especially if exposure to smoke continues. Symptoms may depend on the type of COPD and may include:

• Breathlessness, especially when engaged in physical activity
• Wheezing
• Chest tightness
• Chronic cough that might produce mucus that is clear, white, yellow, or a greenish color
• Respiratory infections that occur frequently
• Swelling in ankles, feet, or legs
• Unintended weight loss (later stage COPD)

Emphysema vs. COPD symptoms
Emphysema	COPD
Shortness of breath, especially while engaging in light exercise or walking up steps Wheezing Long-term cough, often known as a “smoker’s cough” Long-term mucus production An ongoing feeling of fatigue	Shortness of breath, especially when engaged in physical activity Wheezing Chronic cough that produces mucus that is clear, white, yellow, or a greenish color Chest tightness Respiratory infections that occur frequently Swelling in ankles, feet, or legs Unintended weight loss (later stage COPD)

Prevalence

Emphysema

Emphysema is one of the most preventable lung diseases since it is linked to smoking. In 2018, around 2 million adults were diagnosed with this lung disease. Rates of emphysema are higher in men, people aged 65 years and older, and non-Hispanic Whites than in other groups of people. 

COPD

In 2020, 12.5 million people reported a diagnosis of any type of COPD, including emphysema and chronic bronchitis. Rates were higher in women, people over the age of 65, and non-Hispanic Whites. 

Emphysema vs. COPD prevalence
Emphysema	COPD
At least 2 million Americans have been diagnosed with emphysema More common in older adults Women have historically lower rates of emphysema than men More common in non-Hispanic Whites compared to other ethnic and racial groups	At least 12.5 million adults have had a COPD diagnosis  More common in older adults Overall rates higher in women than in men More common in non-Hispanic Whites compared to other ethnic and racial groups

Diagnosis

Emphysema

Your doctor may diagnose emphysema by conducting a medical examination, understanding your medical history, and learning additional information about your symptoms. Your doctor might order tests such as a chest X-ray or a pulmonary function test (PFT), which involves a series of breathing maneuvers. A CT scan can also be used to measure the extent of emphysema that has developed. An arterial blood gas test may be used if emphysema worsens, which helps to measure oxygen and carbon dioxide levels in the blood.

There are three main types of emphysema:

• Centriacinar emphysema: mainly affects the upper parts of your lungs. 
• Panacinar emphysema: often relates to a genetic disorder called alpha-1-antitrypsin deficiency, which affects the entire air sac evenly and tends to affect the lower lungs more. 
• Paraseptal emphysema: damages the outer edges of the lungs and can lead to larger holes in the lung tissue called bullae.

COPD

Your doctor may diagnose COPD by conducting medical examinations, evaluating your symptoms, and assessing your complete medical history. Your doctor may test for COPD by performing PFTs such as spirometry, which tests how well your lungs work. In addition, chest X-rays, CT scans, and other tests might be required to help diagnose COPD.

There are two main types of COPD:

• Chronic bronchitis
• Emphysema

Emphysema vs. COPD diagnosis
Emphysema	COPD
Chest X-ray CT scan Pulmonary function test (PFT) Arterial blood gas test Alpha-1-antitrypsin deficiency blood test	Chest X-ray CT scan Pulmonary function test (PFT) Arterial blood gas test Alpha-1-antitrypsin deficiency blood test

Treatments

Emphysema

While there is no cure for emphysema, there are a few treatment options available to make symptoms more manageable. Your doctor might prescribe medication such as inhaled steroids and bronchodilators. However, the medication prescribed will depend on the severity of the emphysema. 

Other treatment options available include pulmonary emphysema rehabilitation, nutritional therapy, and supplemental oxygen. Depending on the severity, your doctor might recommend surgery. Surgeries may include lung volume reduction surgery or a lung transplant. 

COPD

Many individuals with COPD may have a mild form of the disease, which is why the first line of defense recommended by doctors is to stop smoking. For more advanced forms of the disease, a healthcare provider might recommend medications such as bronchodilators, inhaled corticosteroids, or combination inhalers. However, the most appropriate medication will depend on the severity of the disease. 

Other treatment options include lung therapies such as oxygen therapy to supplement the lack of oxygen in the blood or a pulmonary rehabilitation program. In certain cases, a doctor may suggest an in-home, noninvasive ventilatory support system, which uses a specially designed device and mask to improve breathing. Surgery may be necessary for severe forms of COPD, such as lung volume reduction surgery, a lung transplant, or a bullectomy.

Emphysema vs. COPD treatments
Emphysema	COPD
Inhaled steroids Bronchodilators Supplemental oxygen Pulmonary rehabilitation Lung volume reduction surgery Lung transplant Nutritional therapy	Smoking cessation Combination inhalers Inhaled steroids Bronchodilators Oxygen therapy Pulmonary rehabilitation Lung volume reduction surgery Lung transplant Bullectomy

Risk factors

Emphysema risks

There are various risk factors that may increase an individual’s likelihood of developing emphysema. Smoking is the biggest cause of emphysema, and is, therefore, the greatest risk factor. Smoking may include cigar, pipe, and cigarette smoking. The risk increases with the number of years and amount of tobacco smoked. Other risk factors may include: 

• Age: Individuals with tobacco-related emphysema typically experience symptoms between the ages of 40 and 60.
• Secondhand smoke exposure: Even non-smokers can develop emphysema if they’re regularly exposed to cigarette smoke.
• Occupational exposure: Those who work in environments with fumes, dust, or other harmful airborne particles are at a higher risk.
• Environmental pollution: Both indoor and outdoor air pollutants can increase the likelihood of developing emphysema.
• Genetic factors: Alpha-1 Antitrypsin deficiency, a genetic condition, can lead to emphysema.

COPD risks

There are various risk factors that increase an individual’s chances of being diagnosed with COPD. The greatest risk factor for COPD is long-term exposure to cigarette smoke. The longer a person smokes, the higher the risk. Other risk factors may include:

• Secondhand smoke exposure: Regular exposure to secondhand smoke can also increase the likelihood of developing COPD.
• Asthma: Individuals with a history of asthma are at a higher risk.
• Occupational exposure: Workers exposed to dust and chemicals on the job may be more prone to COPD.
• Genetics: Alpha-1 Antitrypsin deficiency, a genetic condition, increases the risk of developing COPD.
• Age: COPD develops slowly over time, so the majority of people are at least 40 years old when symptoms begin.
• Air pollution: Long-term exposure to outdoor air pollution can contribute to the development of COPD.

Emphysema vs. COPD risk factors
Emphysema	COPD
Smoking and secondhand smoke Older age Long-term exposure to irritants Alpha-1-antitrypsin deficiency Asthma	Smoking and secondhand smoke Older age Long-term exposure to irritants Alpha-1-antitrypsin deficiency Asthma

Emphysema and COPD prevention tips

Emphysema prevention

Since smoking is the main cause of emphysema, the best way to prevent it is by not smoking. In addition, individuals should avoid other lung irritants such as secondhand smoke, air pollution, chemical fumes, and dust.

COPD prevention

Prevention is the same for COPD as it is for emphysema. Smoking cessation and avoiding other lung irritants are examples of methods to prevent COPD. To slow the progression of COPD and optimize their quality of life, patients can also take medication as prescribed and stay current on routine vaccines to prevent pneumonia and influenza.

How to prevent emphysema vs. COPD
Emphysema	COPD
Quitting smoking Avoiding lung irritants Following emphysema treatments as prescribed	Quitting smoking Avoiding lung irritants Following COPD treatments as prescribed

When to see a doctor for emphysema or COPD

If you are experiencing symptoms of emphysema or COPD on a consistent basis, it’s important to visit a doctor or healthcare provider as soon as possible. The early detection of lung disease can help you receive treatment sooner, which may slow the progression of the disease. 

COPD patients, including those with emphysema, may have an increased risk of severe illness from COVID-19, according to the Centers for Disease Control and Prevention (CDC). If you have lung problems, seek medical advice if you experience signs or symptoms of COVID-19, such as fever, cough, shortness of breath, and fatigue. 

Frequently asked questions about emphysema and COPD

What stage of COPD is emphysema?

Emphysema is a type of COPD rather than a stage of it. The stages of COPD, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), are based on symptoms, spirometry testing results, and the number of COPD exacerbations a person experiences. These stages are:

• Stage I (Mild COPD): Few symptoms, and the individual may not know that their lung function is abnormal.
• Stage II (Moderate COPD): Symptoms worsen, and breathing problems become more apparent. People often seek medical attention at this stage.
• Stage III (Severe COPD): More severe symptoms, frequent flare-ups, and further decreased lung function.
• Stage IV (Very severe COPD): This stage is also known as end-stage COPD, with extremely limited airflow and potentially life-threatening flare-ups.

Can you have emphysema without COPD?

Emphysema is a type of COPD. Therefore, if you’ve been diagnosed with emphysema, you have COPD. However, it is possible to have COPD without emphysema. For example, a person may have chronic bronchitis, a form of COPD, which differs from emphysema. 

Differences between emphysema vs. chronic bronchitis

Emphysema and chronic bronchitis, the two main forms of COPD, differ in their main symptoms. Emphysema is characterized by damage to the lungs’ air sacs, causing shortness of breath, even at rest. In contrast, chronic bronchitis involves inflammation of the bronchial tubes leading to a persistent cough. Many people with COPD may have both conditions. Treatment for COPD typically includes medication, lifestyle changes, and in severe cases, oxygen therapy or surgery.

Can you get COPD even if you’ve never smoked?

COPD is most commonly linked to smoking, but non-smokers can get it too. In fact, 1 in 6 COPD patients have never smoked. People may develop COPD due to factors other than smoking. Exposure to air pollution, occupational dust, chemicals, or frequent lower respiratory infections may lead to COPD in non-smokers. 

Resources

• Chronic obstructive pulmonary disease, CDC
• Trends in COPD morbidity and mortality, American Lung Association
• Respiratory diseases, Office of Disease Prevention and Health Promotion
• COPD prevalence, American Lung Association
• COPD, National Heart, Lung, and Blood Institute
• Stages of COPD, Lung Health Institute
• High-risk patients for coronavirus, CDC
• COPD facts, National Heart, Lung, and Blood Institute