COPD: What’s the Difference Between Emphysema and Chronic Bronchitis?

There is one main difference between emphysema and chronic bronchitis. Emphysema is a problem with the alveoli and chronic bronchitis is a problem with inflammation of the bronchi. I’ll elaborate below:

But first, let’s “break the ice” with an NCLEX question about COPD.

A nurse is caring for a patient who has been newly diagnosed with COPD. The nurse is preparing the teaching plan. What would the nurse include? Select all that apply.

  1. Smoking cessation is important to slow or stop the disease progression.
  2. A pulmonary rehabilitation program would offer very little benefit.
  3. A bronchodilator with a metered-dose inhaler should be readily available.
  4. A high humidity environment may increase your work of breathing.
  5. Pneumococcal vaccination is contraindicated for a client with lung disease.

The answers will be at the bottom.

I love to keep things simple. So I really want to explain it simply enough so you can get a basic understanding, eliminate the fluff and then get the NCLEX questions correct. As a bonus, you’ll be able to teach your patient and friends in terms they will understand.

And let me NOT be the first to tell you: if you understand the pathophysiology or cause it will be so much easier to answer NCLEX questions.

Simply put, chronic obstructive pulmonary disease (COPD) is a respiratory disease that causes airflow obstruction. There are 2 diseases that fall under COPD:

  1. emphysema

  2. chronic bronchitis

Emphysema and chronic bronchitis are two separate diseases caused by 2 separate processes. However, typically a patient has both.

1. Alveolar problem:

Emphysema is when the alveoli (those little air sacs in the lungs that exchange CO2 for oxygen) lose their elasticity which causes the lungs to hyperinflate or more commonly known as “barrel chest”. This ends up in a patient that can’t breath well (dyspnea) and an increased respiratory rate (tachypnea). The are also sometimes called “pink puffers” because of all the work they have to put into taking a breath.

But WHY does this happen? WHY!?

Irritants.

Most likely the problem is caused by cigarette smoke or too many campfires. There are these little happy enzymes in your lungs (called proteases) that eliminate the irritants, keeping your lungs nice and healthy. If there too many enzymes (because there’s too many irritants), they damage the alveoli and damage the elastin. Voila! Those little air sacs either get damaged, collapse or become large and flabby, with not a lot area for gas exchange.

2. Airway problem:

Chronic bronchitis is when there is inflammation of the bronchi and bronchioles. What is causing this?

Irritants…the same thing.

Specifically, I’m talking about cigarette smoke…again. But this time, the irritant causes the actual airways to become inflammed, not those little air sacs. Because of all that inflammation, the mucus glands produce a lot of thick mucus and impairs the airflow. That thick mucus is a breeding ground for causing chronic infections. Yuck. These patients are known as “blue bloaters”. This is due to the obstruction: They bloat (AKA look overweight) because the lung volume expands due to the obstruction. And they have a bluish color because they have decreased respirations which makes them hold onto too much carbon dioxide.

Answers:

A nurse is caring for a patient who has been newly diagnosed with COPD. The nurse is preparing the teaching plan. What would the nurse include? Select all that apply.

  1. ANSWER: Smoking cessation is important to slow or stop the disease progression. So obviously, you would choose this because you would want the patient to stop smoking, since smoking causes COPD.
  2. A pulmonary rehabilitation program would offer very little benefit. Obviously a pulmonary rehab program would offer some type of benefit. I mean, you’re dealing with a chronic disease and your patient needs help.
  3. ANSWER: A bronchodilator with a metered-dose inhaler should be readily available. You would want to give a bronchodilator since this would decrease inflammation and you clearly have an inflammation problem.
  4. ANSWER: A high humidity environment may increase your work of breathing. Too much humidity in the air increases work of breathing because humid air is more dense and if it’s more dense it causes more resistance to airflow.
  5. Pneumococcal vaccination is contraindicated for a client with lung disease. Because chronic bronchitis has all that mucus/breeding grounds, you’d want the patient to get their vaccinations against infectious diseases. So give them the pneumococcal vaccine.

Wasn’t that fun?!

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