Chronic obstructive pulmonary disease risk factors

Celik F and Topcu F. 2006. Nutritional risk factors for the development of chronic obstructive pulmonary disease (COPD) in male smokers. Clin Nutr 25(6) 955-961. 

Chronic obstructive pulmonary disease is a respiratory condition characterized by irreversible airway obstruction caused by chronic bronchitis or emphysema. The major symptoms of COPD include chronic cough, increased sputum production, and dyspnea. The vast majority of patients with COPD are those who are current or former heavy smokers. Other risk factors for the development of COPD include occupational exposure (dusts, chemicals) and rare genetic disorders (a -antitrypsin deficiency). The medical management of COPD includes pharmacotherapy (bronchodilators, corticosteroids, and antibiotics) in combination with interventions to reduce risk factors for disease progression (e.g., smoking cessation). Some patients require long-term administration of supplemental oxygen. 

TABLE 27—1. Risk Factors for Development of Chronic Obstructive Pulmonary Disease (COPD)... 

Guite HF, Dundas R, Burney PG. Risk factors for death asthma, chronic obstructive pulmonary disease and cardiovascular disease after an admission for asthma. Thorax 1999 65(4) 301-7. 

Kryda M, Emanuel DA, Marx JJ (1989) Hypersensitivity pneumonitis due to Aspergillus fumigatus in papermill workers. In Principles of health and safety in agriculture. Dosman JA and Cockcroft DW (eds), CRC Press, Boca Raton, p 80 Krzyzanowski M, Jedrychowski W, Wysocki M (1986) Factors associated with the change in ventilatory function and the development of chronic obstructive pulmonary disease in a 13-year follow-up of the Cracow Study. Risk of chronic obstructive pulmonary disease. Am Rev Respir Dis 134(5) 1011-1019... 

Bronchial asthma is characterized by an increased responsiveness of the trachea and bronchi to various stimuli and is manifested by a widespread narrowing of the airways that changes in severity either spontaneously or as a result of therapy (91). Chronic bronchitis is defined as a condition with chronic or recurrent bronchial hypersecretion, cough and expectoration during at least 3 months for at least 2 successive years (92). Chronic bronchitis is often associated with chronic airways obstruction with minimal reversibility it is then called chronic obstructive pulmonary disease (COPD). Chronic airways obstruction in COPD is believed to be caused by either emphysema or irreversible obstructive changes in the peripheral airways, or both. There is an overlap between asthma and COPD, and many patients may have features of both diseases (93). Asthma is considered an important risk factor for the development of COPD. Bronchial hyperresponsiveness is a hallmark of asthma, whereas its importance in COPD is more obscure. Airway inflammation is a key factor for the development of bronchial hyperresponsiveness (94). Table 4 shows the main pathophysiological features of airways obstruction in asthma, chronic bronchitis, and emphysema. 

Branca et al. found that risk factors indicating preoperative medical instabdity, particularly cardiac or pulmonary insufficiency, predicted the highest risk of PMV (>4 days) after cardiac surgery (44). In a study of 139 cardiac surgery patients, chronic obstructive airways disease was identified as a risk factor for patients requiting seven or more days of MV postoperatively (45). In thoracic trauma patients, the presence of bilateral chest injuries, older age, and severity of concomitant head injury predicted the need for more than seven days of MV (46). 

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