Chronic Bronchitis OR Emphysema?

Hello, Dr. Mahler: I have mild/moderate COPD.  I know both Emphysema and Chronic Bronchitis are covered under this term and the treatment is virtually identical,  but I do want to know which primarily I have.  My nurses and doctor refuse to tell me,  do you think this is because they don’t know?  I have only ever had a chest x-ray.   Do I have the right to insist please? I am smoking and my sats are often very low 90’s and even go as low as 90.   Also I have a severe symptom which is not being able to keep up with my peers on the flat.   Are these both down to smoking as they claim,  or could there be some other cause please? Thank you very much. Adele from Manchester, United Kingdom

Dear Adele,

Thanks for your query. The diagnosis of COPD requires breathing tests, whereas a chest x-ray may only suggest this medical problem.

With chronic bronchitis, the person coughs up mucus from the chest most days (at least for 3 months) over at least 2 years.  If you do this, then you do have chronic bronchitis. With emphysema, the main symptom is shortness of breath with activities. A breathing test called the diffusing capacity is lower than normal in those with emphysema.  Some individuals may have components of both chronic bronchitis and emphysema.

It is possible that your doctor may not know the answer to your question if he/she has not ordered pulmonary function tests (PFTs) – commonly called breathing tests.  I suggest that you ask your doctor about ordering these tests.

Views of the inside of a normal breathing tube on left and of chronic bronchitis on the right. Note the white-yellow mucus lining the inside of the airway in chronic bronchitis.

Views of the inside of a normal breathing tube on left and of chronic bronchitis on the right. Note the white-yellow mucus lining the inside of the airway in chronic bronchitis.

Microscopic view of the air sacs (alveoli) in the top right showing emphysema (destruction and enlargement).

Microscopic view of the air sacs (alveoli) in the top right showing emphysema (destruction and enlargement).

It is likely that your breathing difficulty is due to COPD, although heart disease may also cause someone to be short of breath. PFTs are “key” to make sure of the correct diagnosis. If you do have COPD, it is  likely that “not being able to keep up with peers” is due to the narrowing of  your breathing tubes. The narrowing makes it hard to get all of the air out of your lungs when you exhale, and the “trapped air” affects the  ability of your breathing muscles (the diaphragm) to work properly.

On left: Normal size of lungs. On right: lungs are larger due to inability to exhale completely. This is called HYPERINFLATION.

On left: Normal size of lungs.
On right: lungs are larger due to inability to exhale completely. This is called HYPERINFLATION.

I encourage you to quit smoking and to ask your doctor whether inhaled bronchodilator medicine(s) may help you breathe easier  assuming PFTs do show narrowing or obstruction. This information and much more are available in my book COPD: Answers to Your Questions (published February 2015) which is presented on my website.

Best wishes,

Donald A. Mahler, M.D.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.