What’s the Difference Between COPD and Emphysema?

We don’t usually think about our breathing — until it gets harder to do. That’s when terms like COPD and emphysema often start to surface. They’re sometimes used interchangeably, but they aren’t identical.

COPD, or chronic obstructive pulmonary disease, is a broader diagnosis that includes conditions like emphysema and chronic bronchitis. Emphysema, specifically, involves damage to the tiny air sacs in the lungs that help you breathe, known as alveoli.

Knowing the difference between these two terms isn’t just semantics — it can shape treatment, guide outlook, and help people and their caregivers better understand what to expect. Here’s what sets COPD and emphysema apart.

What is COPD?

COPD is a progressive lung disease that makes it hard to breathe. It’s most often caused by cigarette smoking, but it can also be caused by long-term exposure to any irritating gases or particulate matter. 

COPD includes two main conditions:

• Chronic bronchitis: Chronic bronchitis is characterized by inflammation of the lining of the bronchial tubes (the airways that carry air in and out of your lungs). When these tubes get irritated and swollen, they produce more mucus than usual, which leads to a persistent cough and frequent mucus buildup.

• Emphysema: It involves damage to the alveoli, which are tiny air sacs in the lungs where oxygen is passed into the blood. When these air sacs are weakened or destroyed, it becomes harder for the lungs to move oxygen into the body. Emphysema also makes getting rid of carbon dioxide more difficult and thus making it feel harder to breathe.

Most people with COPD actually have a combination of both conditions.

Symptoms of COPD and emphysema

While COPD and emphysema share many symptoms, there are subtle differences.

The symptoms of COPD include:

• Chronic cough

• Excess mucus production

• Shortness of breath, especially during physical activities

• Wheezing

• Chest tightness

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• What could your cough be telling you? From dry to wet, hacking to barking — the sound and feel of a cough can give clues about what’s going on in your body.

• COPD symptoms and treatment needs change over time. COPD is a long-term condition that gets worse over time, but the right treatments can help slow it down. Knowing your stage can help guide you. 

• What to expect from a lung function test: These simple tests measure how well your lungs work and help diagnose conditions like COPD. See how these tests work and what they show.

People with emphysema can experience the following symptoms:

• Shortness of breath, even at rest

• Reduced tolerance for physical activity

• Weight loss

• Barrel-shaped chest

Symptoms can show up differently from person to person, and often overlap — so it’s important to check with a medical professional to get the right diagnosis.

Which is more serious, emphysema or COPD?

Both emphysema and COPD are serious lung conditions that can make everyday tasks — like walking up stairs or getting dressed — feel like real challenges. Emphysema isn’t separate from COPD though, it’s actually one of its main forms, along with chronic bronchitis. So asking which is more serious is a bit like asking whether the engine or the whole car matters more.

Emphysema often points to more advanced damage deep in the lungs, specifically to the alveoli (air sacs). When these sacs are damaged, the lungs can trap stale air, making it harder to breathe in fresh oxygen. This damage tends to be permanent and can lead to more severe breathing difficulties.

That said, severity varies widely. Some people with emphysema have mild symptoms and live relatively normal lives, while others with mixed COPD may face faster decline. How serious it gets depends on lung function, treatment, quitting smoking (if you smoke), and overall health.

How do you treat COPD vs. emphysema​?

Treatment for both COPD and emphysema often overlaps, since emphysema is a type of COPD. The goal is to ease breathing, slow disease progression, and improve quality of life. Here’s a list of some of the available treatments:

• Inhalers: Inhalers, specifically bronchodilators, are often the first line of treatment. These medications relax the muscles around the airways, making it easier to breathe.

• Steroids: Steroids are anti-inflammatory medications that ease swelling in the airways. They can be taken daily as inhalers, to prevent COPD flare-ups (exacerbations). Steroids are also helpful as oral medication (pills) or intravenous injections during a COPD flare to speed up recovery.  

• Oxygen therapy: If your blood oxygen levels are low, supplemental oxygen can help. This is especially common in advanced emphysema, where damaged alveoli can no longer deliver enough oxygen to the bloodstream.

• Pulmonary rehab: This is a program that combines exercise, education, and breathing strategies. It helps people build stamina, reduce shortness of breath, and better manage daily activities.

• Lifestyle changes: If you smoke, quitting smoking is the single most important step you can take. Avoiding air pollution and getting regular exercise can also help preserve lung function.

Can you have COPD and emphysema​?

All people with emphysema have COPD, but not everyone with COPD has emphysema. This is because COPD is an umbrella term that includes both chronic bronchitis and emphysema. The truth, though, is that many people with COPD have features of both emphysema and chronic bronchitis.

Some people may have more airway inflammation and mucus (chronic bronchitis), while others have more damage to the air sacs in the lungs (emphysema). Doctors use lung function tests, symptoms, and imaging (like a CT scan) to understand which type is more prominent. Knowing the specific pattern can help tailor treatment and better manage symptoms.

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Written by:

Farzon A. Nahvi, MD

Farzon Nahvi, MD, is an emergency medicine physician and author of “Code Gray: Death, Life, and Uncertainty in the ER.” He works at Concord Hospital in Concord, New Hampshire, and teaches at the Geisel School of Medicine at Dartmouth.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

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