The Pathogenesis and Pathology of Copd: Identifying Risk

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory condition of the lower airways that includes both emphysema and chronic bronchitis. COPD has some characteristics in common with asthma, but the distinction may be important because of different options for treatment. Development of COPD requires both exposure to noxious stimuli such as tobacco smoke as well as susceptibility to the disease, which is thought to be determined at least partly by genetics. The most important noxious stimulus, by far, is cigarette smoking; so many cases of COPD are preventable. Long-term studies of smokers show that COPD can be identified in its presymptomatic stages and that with smoking cessation, the rates of lung function decline and mortality can be reduced, even in the later stages of the disease. This means that progression to severe disease can be prevented in the vast majority of cases. For persons with more advanced disease, adherence to published guidelines for appropriate therapy can improve symptoms and quality of life, reduce exacerbations, and improve survival. These treatments include smoking cessation, and appropriate use of corticosteroids, long-acting bronchodilators, oxygen, and surgical interventions. Previous nihilistic attitudes about the treatment of COPD are no longer appropriate. (Adv Stud Med. 2004;4(10A):S744-S749) T he development of chronic obstructive pulmonary disease (COPD) requires both exposure to noxious agents and predisposition to the disease. The primary risk factor for COPD is tobacco use (predominantly cigarette smoking), however other environmental exposures may contribute, such as those found in certain occupations or living conditions. Of a group of people with identical exposure history, whether to smoking or to other exposures, only a minority will develop COPD, and those who do will vary in the severity and manifestations of the disease. These discrepancies are thought to be due in part to genetic predisposition to COPD.