Is COPD and Emphysema the same thing?

To get straight to the point: Is COPD and Emphysema the same thing? No.

COPD or Chronic Obstructive Pulmonary Disease is mainly composed of three associated conditions:

  • Chronic bronchitis,
  • Chronic asthma,
  • Emphysema

Lungs Normal vs Inflamed Airway

In each of these conditions, there is a chronic obstruction to the normal flow of air through the airways and the lungs. This obstruction is generally permanent and may be progressive over time.

In COPD the airways in the lungs narrow (bronchi), most often due to cigarette smoke. As the lungs become more affected over time, it becomes increasingly difficult for the person to breathe through the narrow airways. Sometimes the Alveoli are also affected.

When the lesions in the lungs are severe, there will be not enough oxygen in the blood, and the carbon dioxide will be harder to eliminated. These changes lead to further difficulty in breathing and other symptoms.

Unfortunately, COPD symptoms can not be completely treated, and the disease usually worsens over time.

So, before we go further down this road, let me try and explain some important things.

How does the normal human lung function?

Lungs diagramThe lungs do two things :

  1. takes oxygen from the air we inhale and transfers it to the red blood cells on our blood
  2. removes carbon dioxide from the red blood cells and transfers it to the air we exhale.

To make this gas exchange, the lung has two components: the airways and the alveoli.

The respiratory pathways are branched, tubular passages, like the branches of a tree, which allow the air to circulate. The larger segments of the airway are the trachea and the bronchi.

At the end of the bronchiole we have the alveoli, with thin sachets which have small blood vessels in their walls. These are called Capillaries.

Now, the lungs are elastic as you know. When you inhale and exhale the lungs expand and contract. This Pulmonary elasticity is provided by the elastic fibers surrounding the airways and the cell walls of the Alveoli.

In a normal lung, its tissue looks like a sponge. With Emphysema, this tissue often looks like an old sponge with large and irregular holes.

When the pulmonary tissue is destroyed there is a loss of elasticity in the bronchiole can restrict and obstruct airflow, making it a lot harder to breathe. Normally these bronchiole are kept open by pulmonary elasticity. The bronchial walls are weak and have a tendency to crumble, especially as you exhale.

Is COPD and Emphysema the same thing?

Like I said in the beginning, the short answer is No. But lets dig deeper.

COPD stands for Chronic Obstructive Pulmonary Disease, which refers to a couple of lung conditions: Emphysema, Bronchitis and Asthma.

There reason Chronic Bronchitis and Emphysema is often called COPD is simply because these are the most common forms of COPD. Also the treatment for Chronic Bronchitis and Emphysema is very similar.

So, what is Emphysema?

Alveoli with EmphysemaPulmonary Emphysema is characterized by a decrease in pulmonary elasticity, which in turn affects the all breathing mechanics and the volume of air a person can breathe.

Because there is a decrease on the volume of air a person can breathe, then these are the direct consequences:

  • there a decrease in of oxygen being taken in, and made available to our body cells through the blood.
  • there is a increase of Carbon Dioxide in our body

This in turn can lead to:

  • Feeling out of breathe
  • Feeling tired and without energy
  • Dizziness

What causes Emphysema?

Surgeon General's warning cigarettesLet me start by saying the Cigarette Smoking is the leading cause of Emphysema. It is not the only one, but the most common, with the others being inhalation of other smokes such as air pollutants, and some body deficiencies.

First, lets talk about what happens when Cigarette smoke (or other air pollutants) is inhaled.

When we inhale cigarette smoke, this smoke causes irritation in the respiratory system.  This irritation feels to our body like an attack  and will cause a immune response. This immune response comes in the form of Neutrophils, which are the most common type of white blood cells (also called Neutrocytes).

Now bear with me, cause this will take a minute:

The Neutrophils are the immune response to the irritation. They come and attack the irritation cause, the cigarette smoke particles, by ingesting them. This action is called phagocytosis.

To clean up the residual results of this “phagocytosis”, there is another type of white blood cell, the Macrophage. These Macrophage in turn generate more irritation (one type of Macrophage does) and promotes therefore promotes more Neutrophils.

So, it is easy to see that cigarrete smoke leads to a accumulation of Neutrophils.

Now, both Neutrophilis and Mecrophage secrete elastase (Neutrophil elastase), which is a serine proteinase that destroys bacteria and host tissue that during inflammation.

Then, because there is an excessive amount of Elastase, the result is an increase in the elastase activity.

This imbalance leads to tissue destruction, the narrowing of the airways and destruction of the gas exchange zones between air in the lungs and alveolar capillaries. Pulmonary Emphysema.

Over time Chronic Hypoxemia occurs and the heart is affected by the appearance of “chronic lung heart” – a chronic lung disease that affects both the heart and the lungs.

One of the causes of emphysema is alpha 1-antitrypsin deficiency, which is an enzyme that usually stops the destructive action of Elastase.

What are the causes and symptoms of BPOC?

Smoking is responsible for 90% of COPD cases around the world, and although not all smokers develop COPD, it is estimated that 15% do.

Smokers with COPD have :

  • higher rates of death than non-smokers with COPD
  • more frequent respiratory symptoms (cough, dypsnoea, etc.)
  • faster deterioration of lung function than non-smokers

It is important to note that when a patient with COPD stops smoking, the condition begins to improve, therefore, it is never “too late”.

Like we said before, air pollution can cause problems for people with lung disease, but is not clear whether outdoor air pollution contributes to the development of COPD. Most common causes of COPD are in fact caused by indoor air pollution. This is usually due to the indoor stoves used for cooking.

Some COPD symptoms in smokers of 20 cigarettes a day, after more than twenty years:

  • develop a chronic cough,
  • difficulty in breathing and frequent respiratory infections.

Symptoms of emphysema

  • breathing difficulties
  • drowsiness is usually the most visible during physical activity.

In advanced COPD, patients can develop :

  • cyanosis (blue lip discolouration) due to the lack of oxygen in the blood.
  • headaches in the mornings
  • in some patients weight loss.

In advanced COPD, small blood vessels in the lungs are destroyed, and this blocks the flow of blood through the lungs. As a result:

  • the heart needs to pump with increased force.
  • If the heart can not handle additional work, right heart failure, leads to swelling of the feet and ankles.


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