Przewlekła obturacyjna choroba płuc
Etiologia i przyczyny
Przewlekła obturacyjna choroba płuc (POChP) jest chorobą postępującą, charakteryzującą się nieodwracalnym ograniczeniem przepływu powietrza oraz destrukcją tkanek płucnych, wynikającą z przewlekłego stanu zapalnego dróg oddechowych, miąższu i naczyń płucnych. Głównym czynnikiem etiologicznym jest palenie tytoniu, odpowiadające za 75-90% przypadków w krajach rozwiniętych, z ryzykiem rosnącym wraz z liczbą paczkolat. Inne istotne czynniki ryzyka to bierne palenie, zanieczyszczenie powietrza (PM2.5, NO2), ekspozycja zawodowa na pyły i chemikalia (np. pył węglowy, dymy spawalnicze, kadm, izocyjaniany), a także ekspozycja na dym biomasy w krajach o niskim i średnim dochodzie. Genetycznym czynnikiem ryzyka jest niedobór alfa-1 antytrypsyny (AATD), prowadzący do rozedmy płuc, z rozedmą pojawiającą się średnio w wieku 53 lat u niepalących i 40 lat u palaczy. Dodatkowo, astma, infekcje układu oddechowego, wiek powyżej 40 lat, czynniki społeczno-ekonomiczne, płeć żeńska, niedorozwój płuc oraz zakażenie HIV zwiększają ryzyko rozwoju POChP.
- Przyczyny przewlekłej obturacyjnej choroby płuc
- Palenie tytoniu jako główna przyczyna
- Bierne palenie i ekspozycja na dym tytoniowy
- Zanieczyszczenie powietrza i ekspozycja zawodowa
- Zanieczyszczenie powietrza wewnątrz pomieszczeń
- Czynniki genetyczne i niedobór alfa-1 antytrypsyny
- Inne czynniki ryzyka
- Mechanizmy patofizjologiczne
- Wnioski dotyczące przyczyn POChP
Przyczyny przewlekłej obturacyjnej choroby płuc
Przewlekła obturacyjna choroba płuc (POChP) jest postępującą chorobą charakteryzującą się ograniczeniem przepływu powietrza i destrukcją tkanek płucnych, związaną ze strukturalnymi zmianami w płucach spowodowanymi przewlekłym stanem zapalnym. Stan ten rozwija się w wyniku długotrwałej ekspozycji na szkodliwe cząsteczki lub gazy, które prowadzą do zapalenia dróg oddechowych, miąższu płuc i naczyń płucnych1. Etiologia POChP jest złożona i obejmuje zarówno czynniki środowiskowe, jak i genetyczne.
Palenie tytoniu jako główna przyczyna
Palenie tytoniu stanowi najważniejszy i najczęstszy czynnik ryzyka rozwoju POChP, odpowiadający za około 75-90% wszystkich przypadków w krajach rozwiniętych12. W krajach o wysokim dochodzie palenie tytoniu odpowiada za ponad 70% przypadków POChP, podczas gdy w krajach o niskim i średnim dochodzie odsetek ten wynosi 30-40%1. Dym tytoniowy zawiera ponad 7000 różnych substancji chemicznych, z których wiele ma działanie szkodliwe dla płuc1. Substancje te osłabiają mechanizmy obronne płuc przeciwko infekcjom, zwężają drogi oddechowe, powodują obrzęk oskrzeli oraz niszczą pęcherzyki płucne1.
Ryzyko rozwoju POChP wzrasta wraz z intensywnością palenia i czasem ekspozycji na dym tytoniowy1. Im więcej papierosów osoba wypali w ciągu życia (liczba paczkolat), tym większe jest ryzyko zachorowania1. Warto jednak podkreślić, że tylko około 15-20% palaczy rozwinie klinicznie istotną POChP, co wskazuje na rolę dodatkowych czynników w patogenezie choroby12.
Ryzyko POChP dotyczy nie tylko osób palących papierosy, ale również palaczy fajki, cygar i marihuany12. Także używanie e-papierosów i innych produktów tytoniowych zwiększa ryzyko rozwoju POChP1.
Bierne palenie i ekspozycja na dym tytoniowy
Bierne palenie (ekspozycja na dym tytoniowy z otoczenia) również stanowi istotny czynnik ryzyka rozwoju POChP12. Długotrwała ekspozycja na dym tytoniowy w otoczeniu może prowadzić do podobnych uszkodzeń płuc jak aktywne palenie, choć zwykle o mniejszym nasileniu1. Szczególnie narażone są osoby mieszkające z palaczami lub pracujące w środowisku, gdzie występuje dym tytoniowy1.
Zanieczyszczenie powietrza i ekspozycja zawodowa
Zanieczyszczenie powietrza, zarówno zewnętrznego, jak i wewnętrznego, stanowi drugi istotny czynnik ryzyka POChP1. Długotrwała ekspozycja na cząsteczki PM2.5 i dwutlenki azotu zwiększa ryzyko rozwoju POChP1. Źródłami zanieczyszczeń powietrza mogą być pojazdy silnikowe, fabryki, elektrownie oraz spalanie drewna i pożary1.
Narażenie zawodowe na pyły, chemikalia, opary i dymy stanowi kolejny istotny czynnik etiologiczny, odpowiadający za 10-20% przypadków POChP1. Szczególnie narażone są osoby pracujące w branżach takich jak górnictwo, budownictwo, przemysł włókienniczy i metalurgiczny12. Ryzyko rozwoju POChP jest jeszcze wyższe, jeśli ekspozycja zawodowa współistnieje z paleniem tytoniu12.
Do najczęstszych zawodowych czynników ryzyka POChP należą:12
- Pyły mineralne i organiczne (np. pył węglowy, ziarna, krzemionka)
- Dymy spawalnicze
- Kadm i jego związki
- Izocyjaniany (występujące w farbach samochodowych i lakierach)
- Chemikalia przemysłowe i rozpuszczalniki
Zanieczyszczenie powietrza wewnątrz pomieszczeń
W krajach rozwijających się znaczącym czynnikiem ryzyka POChP jest ekspozycja na dym powstający podczas spalania biomasy (drewna, odchodów zwierzęcych, pozostałości roślinnych) lub węgla używanych do gotowania i ogrzewania w słabo wentylowanych pomieszczeniach12. WHO szacuje, że zanieczyszczenie powietrza wewnątrz pomieszczeń jest głównym czynnikiem ryzyka POChP w krajach o niskim i średnim dochodzie1.
Czynniki genetyczne i niedobór alfa-1 antytrypsyny
Niedobór alfa-1 antytrypsyny (AATD) jest rzadkim, genetycznie uwarunkowanym czynnikiem ryzyka POChP1. Jest to dziedziczny stan, który wpływa na zdolność organizmu do produkcji białka (alfa-1 antytrypsyny) chroniącego płuca przed uszkodzeniami1. Niedobór AAT jest najczęstszą genetyczną przyczyną rozedmy płuc i może prowadzić do rozwoju POChP nawet u osób, które nigdy nie paliły12.
AATD prowadzi do zaburzenia równowagi między proteazami i antyproteazami, co pozostawia miąższ płuc narażony na uszkodzenia wywołane przez proteazy1. U osób z ciężkim niedoborem alfa-1 antytrypsyny rozedma pojawia się średnio w wieku 53 lat u niepalących i 40 lat u palaczy1.
Poza niedoborem alfa-1 antytrypsyny, badania sugerują, że także inne czynniki genetyczne mogą zwiększać podatność na rozwój POChP1. Osoby palące, które mają krewnych z POChP, mają większe ryzyko zachorowania1. Zidentyfikowano ponad 30 alleli genetycznych związanych z POChP lub spadkiem funkcji płuc, choć żaden z nich nie okazał się tak istotny jak niedobór alfa-1 antytrypsyny1.
Inne czynniki ryzyka
Oprócz wymienionych głównych przyczyn, istnieje wiele innych czynników zwiększających ryzyko rozwoju POChP:
- Astma – osoby z astmą, zwłaszcza nieodpowiednio kontrolowaną, mają zwiększone ryzyko rozwoju POChP1. Badania pokazują, że osoby z astmą mają nawet 12,5 razy wyższe ryzyko rozwoju POChP niż osoby bez astmy12.
- Infekcje układu oddechowego – ciężkie lub nawracające infekcje dróg oddechowych w dzieciństwie mogą wpływać na rozwój płuc i zwiększać ryzyko POChP w przyszłości12.
- Chroniczne zakażenia płuc – takie jak gruźlica, są szczególnie powiązane z POChP1.
- Wiek – POChP występuje najczęściej u osób powyżej 40. roku życia, a ryzyko rośnie wraz z wiekiem12.
- Czynniki społeczno-ekonomiczne – niższy status społeczno-ekonomiczny wiąże się z większym ryzykiem POChP12. Osoby żyjące w ubóstwie i na obszarach wiejskich są bardziej narażone na rozwój choroby, częściowo z powodu większej ekspozycji na zanieczyszczenia, gorszych warunków mieszkaniowych i ograniczonego dostępu do opieki zdrowotnej1.
- Płeć – kobiety mogą być bardziej wrażliwe na czynniki ryzyka POChP niż mężczyźni1.
- Niedorozwój płuc – czynniki wpływające na wzrost i rozwój płuc w okresie życia płodowego, takie jak palenie przez matkę w ciąży, wcześniactwo lub niska masa urodzeniowa, mogą zwiększać ryzyko POChP w późniejszym życiu12.
- Zakażenie HIV – zostało zidentyfikowane jako niezależny czynnik ryzyka POChP, nawet po uwzględnieniu czynników zakłócających, takich jak palenie tytoniu, używanie narkotyków dożylnych, rasa i wiek1.
- Dożylne zażywanie narkotyków – rozedma występuje u około 2% osób używających narkotyków dożylnie1.
Mechanizmy patofizjologiczne
POChP rozwija się w wyniku złożonych procesów patofizjologicznych, które obejmują:123
- Przewlekły stan zapalny – długotrwała ekspozycja na szkodliwe cząsteczki i gazy prowadzi do przewlekłego stanu zapalnego w drogach oddechowych, miąższu płuc i naczyniach płucnych. Stan zapalny obejmuje zwiększoną liczbę makrofagów, neutrofili i limfocytów T w różnych częściach płuc.
- Stres oksydacyjny – dym papierosowy jest głównym źródłem czynników utleniających w płucach, ale komórki zapalne i fagocyty znajdujące się w drogach oddechowych również generują reaktywne formy tlenu (RFT) w płucach. Stres oksydacyjny jest jedną z głównych przyczyn patogenezy POChP, wywołując apoptozę, przebudowę macierzy pozakomórkowej, inaktywację inhibitorów proteaz i inne mechanizmy uszkadzające.
- Zaburzenie równowagi proteazy-antyproteazy – zaburzenie tej równowagi odgrywa kluczową rolę w patogenezie POChP. Wzrost enzymów elastolitycznych, takich jak metaloproteinazy macierzy (MMP), powoduje degradację macierzy pozakomórkowej i niszczenie ścian pęcherzyków płucnych.
- Elastoliza – rozpad włókien elastycznych jest jedną z głównych cech rozedmy płuc, ważnego fenotypu przyczyniającego się do POChP.
Powyższe procesy prowadzą do charakterystycznych zmian strukturalnych w płucach, takich jak rozedma (destrukcja ścian pęcherzyków płucnych, zwiększenie przestrzeni powietrznych i utrata sprężystości płuc) oraz przewlekłe zapalenie oskrzeli (pogrubienie ścian oskrzeli i zwiększona produkcja śluzu)1. Zmiany te skutkują postępującym ograniczeniem przepływu powietrza, które nie jest w pełni odwracalne i stopniowo się pogłębia1.
Wnioski dotyczące przyczyn POChP
POChP jest złożoną, heterogenną i wieloczynnikową chorobą, której rozwój zależy od interakcji między czynnikami środowiskowymi a predyspozycją genetyczną1. Główną przyczyną pozostaje palenie tytoniu, odpowiedzialne za większość przypadków w krajach rozwiniętych, jednak coraz większe znaczenie przypisuje się innym czynnikom, takim jak zanieczyszczenie powietrza, ekspozycja zawodowa i predyspozycje genetyczne1.
Zapobieganie POChP opiera się przede wszystkim na eliminacji czynników ryzyka, szczególnie zaprzestaniu palenia tytoniu oraz ograniczeniu ekspozycji na szkodliwe cząsteczki i gazy w środowisku pracy i zamieszkania12. Wczesne rozpoznanie i odpowiednie leczenie mogą spowolnić postęp choroby, zmniejszyć częstość zaostrzeń i poprawić jakość życia pacjentów1.
Lepsze zrozumienie złożonej etiologii POChP i mechanizmów prowadzących do rozwoju choroby jest kluczowe dla opracowania skuteczniejszych strategii profilaktycznych i terapeutycznych12.
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Materiały źródłowe
- #1 Chronic Obstructive Pulmonary Disease – StatPearls – NCBI Bookshelfhttps://www.ncbi.nlm.nih.gov/books/NBK559281/
COPD is caused by prolonged exposure to harmful particles or gases. Cigarette smoking is the most common cause of COPD worldwide. Other causes may include second-hand smoke, environmental and occupational exposures, and alpha-1 antitrypsin deficiency (AATD). […] Chronic obstructive pulmonary disease (COPD) is a common and treatable disease characterized by progressive airflow limitation and tissue destruction. It is associated with structural lung changes due to chronic inflammation from prolonged exposure to noxious particles or gases most commonly cigarette smoke. […] COPD is primarily present in smokers and those greater than age 40. Prevalence increases with age and it is currently the third most common cause of morbidity and mortality worldwide. […] COPD is an inflammatory condition involving the airways, lung parenchyma, and pulmonary vasculature. The process is thought to involve oxidative stress and protease-antiprotease imbalances.
- #1 COPD Causes and Risk Factors | American Lung Associationhttps://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/what-causes-copd
Over time, exposure to lung irritants like tobacco smoke or chemicals can damage your lungs and airways. This long-term exposure can cause chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema. The leading cause of COPD is smoking, however 1 in 4 people living with COPD never smoked. […] About 75 percent of all COPD cases occur in people with a history of smoking. When a cigarette burns, it creates more than 7,000 chemicals and many are harmful. The chemicals in cigarette smoke weaken your lungs’ defense against infections, narrow air passages, cause swelling in air tubes and destroy air sacsâall contributing factors for COPD. Using other tobacco products like e-cigarettes and cigars also increase your risk of developing COPD. […] Ongoing and long-term exposure to chemicals, dust and fumes are environmental risks for COPD. Occupational exposures account for 10-20% of either respiratory symptoms or lung function impairment consistent with COPD.
- #1https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide, causing 3.5 million deaths in 2021, approximately 5% of all global deaths. […] Tobacco smoking accounts for over 70% of COPD cases in high-income countries. In LMIC tobacco smoking accounts for 30-40% of COPD cases, and household air pollution is a major risk factor. […] Smoking and air pollution are the most common causes of COPD. […] Several processes can cause the airways to become narrow and lead to COPD. […] COPD develops gradually over time, often resulting from a combination of risk factors: tobacco exposure from active smoking or passive exposure to second-hand smoke; occupational exposure to dusts, fumes or chemicals; indoor air pollution: biomass fuel (wood, animal dung, crop residue) or coal is frequently used for cooking and heating in low- and middle-income countries with high levels of smoke exposure; early life events such as poor growth in utero, prematurity, and frequent or severe respiratory infections in childhood that prevent maximum lung growth; asthma in childhood; and a rare genetic condition called alpha-1 antitrypsin deficiency, which can cause COPD at a young age. […] Reducing tobacco smoke exposure is important for both primary prevention of COPD and disease management.
- #1 COPD: causes, symptoms and treatment | Health & wellness | UnitedHealthcarehttps://www.uhc.com/health-and-wellness/health-topics/copd-causes-symptoms-and-treatment
COPD develops when your lungs and airways are exposed to irritants (like smoke and chemicals) over time. While smoking is the main cause of COPD, nonsmokers can get it too. […] Cigarette smoking causes about 85 to 90 percent of all COPD cases. The toxins in cigarette smoke weaken your lungs’ defense against infections. They also narrow air passages, cause swelling in air tubes and damage air sacs. Together, all these factors cause COPD to develop. […] You may not even think about it, but the air you breathe can have an impact on your health. Whether at home or at work, long-term exposure to secondhand smoke, air pollution, fumes and chemicals can cause COPD. […] A small number of people have a rare form of COPD called alpha-1 deficiency-related emphysema. Its genetic, which means you inherit it from your family. This type of COPD affects your body’s ability to produce a protein (alpha-1) that protects your lungs.
- #1 Chronic Obstructive Pulmonary Disease (COPD) – Pulmonology Advisorhttps://www.pulmonologyadvisor.com/ddi/chronic-obstructive-pulmonary-disease-copd/
COPD is caused by prolonged exposure to harmful particles or gasses, usually from cigarette smoke. Smoking is the most common etiology of COPD worldwide, causing approximately 85 to 90% of all chronic obstructive pulmonary disease cases. Overall, 10% to 15% of smokers develop COPD. It should be noted that symptoms depend on the intensity of smoking, years of exposure, and baseline lung function. The more a person smokes, both in terms of years and volume of consumption (overall number of cigarettes), the greater the persons risk of COPD. This risk is not limited to cigarette smokers but applies to pipe smokers, cigar smokers, and marijuana smokers. […] Other possible causes of chronic obstructive pulmonary disease include: Secondhand smoke, Environmental and occupational exposures to air pollutants and chemicals chronic exposure to vapors, chemical fumes, and dusts can irritate and inflame the lungs, Alpha-1 antitrypsin deficiency (AATD) a genetic disorder that reduces the protective protein in the lungs.
- #1 Causes and Risk Factors of COPDhttps://www.health.com/copd-causes-7094903
Up to 90% of COPD cases are linked to cigarette smoking. The more a person smokes, as well as the longer they smoke, can increase the risk and severity of the disease. […] Exposure to chemicals and fumes of harmful substances at work can damage the lungs and increase your risk of COPD. Long-term exposure to grain and flour dust, coal mine dust, welding fumes, silica, cadmium, and isocyanates (common in auto body paints and varnishes) have all been linked to COPD. […] Both indoor and outdoor pollutants can irritate airways and harm lung health. Smog (smoke and fog) is outdoor air pollution that contains many particles. Some of these particles can damage the lungs and airways and increase your chances of developing COPD. […] Having asthma as a child or as an adult is associated with a higher risk of COPD. Research has shown that people with asthma have a 12.5 times higher risk of the disease than those who do not. […] COPD occurs when damage from smoking or long-term exposure to harmful irritantsâchemical fumes, dust, and pollutionâcauses the airways to become inflamed and swollen, making it hard to breathe.
- #1 Chronic Obstructive Pulmonary Disease (COPD) – Pulmonary Disorders – Merck Manual Professional Editionhttps://www.merckmanuals.com/professional/pulmonary-disorders/chronic-obstructive-pulmonary-disease-and-related-disorders/chronic-obstructive-pulmonary-disease-copd
Chronic obstructive pulmonary disease (COPD) is airflow limitation caused by an inflammatory response to inhaled toxins, often cigarette smoke. […] There are 2 main causes of COPD: Smoking (and less often other inhalational exposures) and Genetic factors. […] Of all inhalational exposures, cigarette smoking is the primary risk factor in most countries, although only approximately 15% of people who smoke develop clinically apparent COPD. […] The best-defined causative genetic disorder is alpha-1 antitrypsin deficiency, which is an important cause of emphysema in people who do not smoke and markedly increases susceptibility to disease in people who do. […] More than 30 genetic alleles have been found to be associated with COPD or decline in lung function in selected populations, but none has been shown to be as consequential as alpha-1 antitrypsin.
- #1https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/causes/
Chronic obstructive pulmonary disease (COPD) happens when the lungs and airways become damaged and inflamed. […] It’s usually associated with long-term exposure to harmful substances such as cigarette smoke. […] Smoking is the main cause of COPD and is thought to be responsible for around 9 in every 10 cases. […] Some research also suggests that being exposed to other people’s cigarette smoke (passive smoking) may increase your risk of COPD. […] Exposure to certain types of dust and chemicals at work may damage the lungs and increase your risk of COPD. […] The risk of COPD is even higher if you breathe in dust or fumes in the workplace and you smoke. […] Exposure to air pollution over a long period can affect how well the lungs work and some research suggests it could increase your risk of COPD. […] You’re more likely to develop COPD if you smoke and have a close relative with the condition, which suggests some people’s genes might make them more vulnerable to the condition. […] People with alpha-1-antitrypsin deficiency can go on to develop COPD.
- #1 COPD – Causes and Risk Factors | NHLBI, NIHhttps://www.nhlbi.nih.gov/health/copd/causes
Cigarette smoking is the most common cause of COPD in the United States. Long-term smoking or breathing in tobacco smoke or pollutants in the air damages the lungs and airways. […] The following may raise your risk of COPD: […] Smoking: This is the main risk factor for COPD. Three out of four people who have COPD smoke or used to smoke. People who have a family history of COPD are more likely to develop the disease if they smoke. […] Other lung irritants: These may include long-term exposure to air pollution, chemical fumes and dust from the environment or workplace, smoke from home cooking and heating fuels without ventilation, and secondhand smoke, which is smoke in the air from other people smoking. […] Changes to lung growth and development: Conditions affecting the lungs when a baby is still in the uterus or during childhood can increase the risk. Examples include smoking in pregnancy or childhood asthma. Air pollution can also limit the growth of a child’s lungs and increase their risk of developing COPD. […] A condition that runs in families, called alpha-1 antitrypsin (AAT) deficiency: If you are born with this condition, smoking or long-term exposure to fumes or dust can lead to lung damage and COPD. AAT deficiency can also raise your risk for developing COPD at a younger age.
- #1 COPD Causes and Risk Factors | American Lung Associationhttps://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/what-causes-copd
Long-term exposure to particulate matter PM 2.5 and nitrogen dioxides increases your risk of developing COPD. Sources of PM 2.5 are motor vehicles, factories, powerplants, wood burning and wildfires. Exposure to poor air quality worsens symptoms and accelerates lung function decline in adults, especially if you have other risk factors for COPD. […] Alpha-1 antitrypsin (AATD) deficiency is a genetic or inherited condition that affects the body’s ability to produce a protein (Alpha-1) that protects the lungs. Alpha-1 is the most common genetic form of emphysema and can only be diagnosed by using a blood test. […] COPD is often referred to as a „smokerâs disease” however although smoking is one of the main risk factors for developing COPD, people who never smoke may also develop COPD. Other risk factors may include: A history of childhood respiratory infections, Smoke exposure from coal or wood burning stove, Exposure to secondhand smoke, People with a history of asthma, People who have underdeveloped lungs, Those who are age 40 and older as lung function declines as you age.
- #1https://www.advocatehealth.com/health-services/lung-respiratory-care/chronic-obstructive-pulmonary-disease-copd
COPD is caused by long-term exposure to chemicals, cigarette smoke, air pollution or dust. […] The leading cause of COPD is smoking cigarettes. Other COPD causes include long-term exposure to lung irritants such as air pollutants and breathing in chemicals in the workplace. […] Tobacco smoke: This is the most common cause of COPD, particularly in developed countries. Many people with chronic obstructive pulmonary disorder are long-term smokers or were former smokers. […] Exposure to dusts and chemicals: Certain industrial pollutants, dust and chemical fumes can also cause COPD. Workers in certain industries such as mining, construction and cotton textile manufacturing are at a higher risk. […] Air pollution: Chronic exposure to outdoor air pollution (smog) and indoor air pollution (fuel used for cooking and heating) can lead to COPD. […] Genetics: Alpha-1 Antitrypsin Deficiency (AATD) is a genetic condition that can cause COPD, even in people who have never smoked or been exposed to pollutants. People with this deficiency have low levels of alpha-1 antitrypsin (AAT), a protein that protects the lungs.
- #1 Chronic obstructive pulmonary disease (COPD) – Etiology | BMJ Best Practice UShttps://bestpractice.bmj.com/topics/en-us/7/aetiology
Tobacco smoking is the main risk factor for COPD. […] Tobacco smoking causes over 70% of COPD cases in high-income countries and 30% to 40% of cases in low- and middle-income countries. […] Air pollution, indoor burning of biomass fuels, and occupational exposure to dusts, chemical agents, and fumes are other etiologies. […] Inhalation of high doses of pesticides is linked to increased incidence of COPD, as are high levels of particulate matter. […] Oxidative stress and an imbalance in proteases and antiproteases are also important factors in the pathogenesis of COPD, especially in patients with alpha-1 antitrypsin deficiency. […] The risk of developing COPD can be increased by processes that affect optimal lung growth and therefore lung function. […] These processes may go back as far as gestation, birth, childhood, and adolescence. Disadvantageous factors in childhood may be as important as heavy smoking in predicting lung function in adulthood.
- #1 Chronic Obstructive Pulmonary Disease – StatPearls – NCBI Bookshelfhttps://www.ncbi.nlm.nih.gov/books/NBK559281/
Alpha-1 antitrypsin deficiency is a rare cause of emphysema which involves a lack of antiproteases and the imbalance leaves the lung parenchyma at risk for protease-mediated damage. […] The primary goals of treatment are to control symptoms, improve the quality of life, and reduce exacerbations and mortality. […] The classes of commonly used medications in COPD include bronchodilators (beta2-agonists, antimuscarinics, methylxanthines), inhaled corticosteroids (ICS), systemic glucocorticoids, phosphodiesterase-4 (PDE4) inhibitors, and antibiotics. […] COPD is a chronic inflammatory lung disease causing tissue destruction and irreversible airflow limitation. […] Smoking is the most common risk factor worldwide. […] Diagnosis is made by spirometry with a post-bronchodilator FEV1/FVC ratio 0.7. […] Patients should avoid smoking and other harmful exposures.
- #1 COPD: Causes, Symptoms, Diagnosis, Treatment & Preventionhttps://my.clevelandclinic.org/health/diseases/8709-chronic-obstructive-pulmonary-disease-copd
Chronic obstructive pulmonary disease (COPD) is a term for certain types of irreversible lung and airway damage that block (obstruct) your airways and make it hard to breathe. […] Damage to your lungs from smoking is the most common cause of COPD. Other causes include: Alpha-1 antitrypsin deficiency (alpha-1), a genetic disorder that can lead to lung damage. […] While smoking is the biggest risk factor for COPD, not everyone who smokes will develop it. […] COPD can trap bacteria in your lungs, leading to infections. It can also prevent oxygen from getting into your body and carbon dioxide from getting out. […] The best way to prevent COPD is to avoid smoking and exposure to secondhand smoke and other pollutants that can damage your lungs. […] The damage to your lungs from COPD is permanent and doesn’t get better.
- #1 Chronic Obstructive Pulmonary Disease (COPD): Practice Essentials, Background, Pathophysiologyhttps://emedicine.medscape.com/article/297664-overview
COPD does occur in individuals who have never smoked. […] Although the role of air pollution in the etiology of COPD is unclear, the effect is small when compared with that of cigarette smoking. In developing countries, the use of biomass fuels with indoor cooking and heating is likely to be a major contributor to the worldwide prevalence of COPD. […] Severe AAT deficiency leads to premature emphysema at an average age of 53 years for nonsmokers and 40 years for smokers. […] Emphysema occurs in approximately 2% of persons who use intravenous (IV) drugs. […] Human immunodeficiency virus (HIV) infection has been found to be an independent risk factor for COPD, even after controlling for confounding variables such as smoking, IV drug use, race, and age. […] Hypocomplementemic vasculitis urticaria syndrome (HVUS) may be associated with obstructive lung disease.
- #1 Chronic Obstructive Pulmonary Disease (COPD) – Pulmonology Advisorhttps://www.pulmonologyadvisor.com/ddi/chronic-obstructive-pulmonary-disease-copd/
Additional risk factors that may raise the risk of developing COPD include: Repeat or severe respiratory infections, or a history of childhood respiratory infections, Allergies, Asthma a chronic inflammatory airway disease that may be a risk factor, especially when combined with smoking. About 1 in 5 people with COPD have asthma. Genetic factors factors beyond Alpha-1-antitrypsin deficiency are likely to increase the susceptibility of COPD in certain smokers.
- #1 Causeshttps://www2.hse.ie/conditions/copd/copd-causes/
You’re more likely to develop COPD if you smoke and have a close relative with the condition. […] Some patients with COPD have a genetic tendency to develop a condition called alpha-1-antitrypsin deficiency. […] People who have an alpha-1-antitrypsin deficiency usually develop COPD at a younger age.
- #1 COPD Causes: Smoking & 7 Other Things That May Cause COPDhttps://www.webmd.com/lung/copd/what-causes-copd
Asthma: Poorly controlled asthma can raise the risk for developing COPD. […] Things that can make you more likely to get COPD include: […] Smoking: This is the most common cause of COPD. […] Asthma: Your chances are even higher if you have asthma and you smoke. […] Age: Most people are 40 or older when their symptoms start up. […] Certain jobs: If your job puts you around dust, chemical fumes, or vapors, your lungs can get damaged. Damage can also come from prolonged exposure to air pollution. […] Infections: If you had lots of respiratory infections in childhood, you have a greater chance of COPD in adulthood.
- #1 COPD Causes and Risk Factorshttps://www.verywellhealth.com/copd-causes-risk-factors-914865
If you have asthma, even if you’ve never smoked, research shows that your risk of developing COPD may be up to 12 times higher than those who don’t have asthma. […] Severe viral and bacterial lung infections in early childhood have been associated with reduced lung function and increased respiratory symptoms in adulthood, which contributes to the development of COPD. […] Chronic lung infections, such as tuberculosis, are especially linked to COPD. […] Having a lower socioeconomic status poses an increased risk of developing COPD, especially during childhood. […] Women may have a higher sensitivity to COPD risk factors than men. […] Alpha-1-antitrypsin (AAT) deficiency is a rare genetic disorder responsible for a small number of cases of COPD. […] If you have an AAT deficiency, whether or not you’re exposed to smoke or other lung irritants, you can develop COPD simply because your body doesn’t make enough of the AAT protein, which protects your lungs from damage. […] Other possible COPD contributing factors include deficient lung function and malnutrition.
- #1 COPD Causes and Risk Factors | American Lung Associationhttps://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/what-causes-copd
While these causes and risk factors may increase your risk of developing COPD, people living in poverty and people living in rural areas are more likely to develop COPD. Beyond smoking status, some reasons for the increased risk of developing COPD may include exposures to indoor and outdoor pollutants, occupational exposures and lack of access to healthcare.
- #1 Chronic obstructive pulmonary disease | Radiology Reference Article | Radiopaedia.orghttps://radiopaedia.org/articles/chronic-obstructive-pulmonary-disease-1?lang=us
Emphysema involves the destruction of alveolar septa and pulmonary capillaries, leading to decreased elastic recoil and resultant air trapping. The morphological subtypes of emphysema include: centrilobular (centriacinar): associated with smoking and spreads peripherally from bronchioles, panacinar: homozygous AAT1 deficiency and uniformly destroys alveoli, paraseptal (distal acinar): involves the distal airways. […] Barring whole-lung transplantation, there is no cure for COPD, but it is highly preventable and treatable.
- #1 Mechanisms, Pathophysiology and Currently Proposed Treatments of Chronic Obstructive Pulmonary Diseasehttps://www.mdpi.com/1424-8247/14/10/979
Chronic obstructive pulmonary disease (COPD) is one of the leading global causes of morbidity and mortality. A hallmark of COPD is progressive airflow obstruction primarily caused by cigarette smoke (CS). […] Tobacco smoking and inhalation of other pollutants are the leading causes of COPD. […] The prevalence and burden of COPD will increase in the coming decades due to continued exposure to risk factors and aging of the world population. […] The pathogenesis of emphysema includes destruction of alveolar septa, increased air space, and loss of elastic recoil due to hyperinflammation and oxidative stress. […] The breakdown of elastic fibers, so-called elastolysis, is one of the hallmarks of emphysema, an important phenotype contributing to COPD. […] COPD is characterized by progressive airflow limitation that is not fully reversible, associated with an abnormal inflammatory response of the lungs to noxious particles or gases.
- #1 The etiologic origins for chronic obstructive pulmonary disease | COPDhttps://www.dovepress.com/the-etiologic-origins-for-chronic-obstructive-pulmonary-disease-peer-reviewed-fulltext-article-COPD
Early life air pollution exposure including traffic-derived CO, NO, NO2, PM2.5, PM10, SO2, and black carbon appears to influence the development of airway diseases and increase risk of respiratory diseases, including COPD and asthma in later life. […] COPD is a heterogeneous and multifactorial disease. […] COPD induced by active smoking, ambient particulate matter pollution, occupational particulate matter/gases/fumes, ambient ozone pollution, household air pollution from solid fuels, secondhand smoke, and lead exposure was responsible for about 3.46 million of global all-age deaths and 79.78 million of disability-adjusted life-years (DALYs) in 2017. […] COPD emerges as an enormous challenge to global health.
- #1 COPD & Emphysema: Causes and Treatment | Columbia Surgeryhttps://columbiasurgery.org/conditions-and-treatments/emphysema-and-chronic-obstructive-pulmonary-disease-copd
COPD is a group of diseases that cause damage to the lungs and restrict their ability to obtain oxygen, restricting oxygen flow in the blood. […] Most COPD is related to cigarette smoking, but recent evidence suggests that 25% of those with COPD never smoked. Increasingly environmental factors are felt to play a role in the development and worsening of COPD. There is also an inherited form of COPD called alpha-1 antitrypsin deficiency. […] All COPD is not the same. There are those with more of a chronic bronchitic form of COPD and some with a more emphysematous form, meaning it is related to emphysema.
- #1https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/
Chronic obstructive pulmonary disease (COPD) is the name for a group of lung conditions that cause breathing difficulties. […] COPD happens when the lungs become inflamed, damaged and narrowed. The main cause is smoking, although the condition can sometimes affect people who have never smoked. […] The likelihood of developing COPD increases the more you smoke and the longer you’ve smoked. […] Some cases of COPD are caused by long-term exposure to harmful fumes or dust. Others are the result of a rare genetic problem that makes the lungs more vulnerable to damage. […] COPD is largely a preventable condition. You can significantly reduce your chances of developing it if you avoid smoking.
- #1 Chronic obstructive pulmonary disease: Diagnosis and staging – UpToDatehttps://www.uptodate.com/contents/chronic-obstructive-pulmonary-disease-diagnosis-and-staging
Chronic obstructive pulmonary disease (COPD) is a common respiratory condition characterized by cough, dyspnea, and airflow limitation. Approximately 10 percent of individuals aged 40 years or older have COPD, although the prevalence varies between countries and increases with age. COPD is consistently ranked among the top causes of death in the United States, killing more than 120,000 individuals each year; prior to the COVID-19 pandemic, it was the third leading cause worldwide. Establishing a correct diagnosis of COPD is important because appropriate management can decrease symptoms (especially dyspnea), reduce the frequency and severity of exacerbations, improve health status, improve exercise capacity, and prolong survival. […] The definition, clinical manifestations, diagnostic evaluation, and staging of COPD are discussed here. […] Classification of COPD by etiology („etiotype”).
- #1 The etiologic origins for chronic obstructive pulmonary disease | COPDhttps://www.dovepress.com/the-etiologic-origins-for-chronic-obstructive-pulmonary-disease-peer-reviewed-fulltext-article-COPD
COPD attributed to active smoking, ambient particulate matter pollution, occupational particulate matter/gases/fumes, ambient ozone pollution, household air pollution from solid fuels, secondhand smoke, and lead exposure was responsible for about 3.46 million of global all-age deaths and 79.78 million of disability-adjusted life-years (DALYs) in 2017. […] Therefore, addressing the predisposing factors of COPD and prevent its development seem to be an appropriate intervention strategy for control of the disease in public health. […] Understanding the effects of risk factors correlated with the development of this disease on population at their different life stages is necessary so that more preventive strategies may be developed. […] In this review, we will provide a broad overview of etiologic origins for COPD, and try to find some potential preventive strategies and new insights for COPD studies.
- #2 Chronic Obstructive Pulmonary Disease (COPD) – Pulmonology Advisorhttps://www.pulmonologyadvisor.com/ddi/chronic-obstructive-pulmonary-disease-copd/
COPD is caused by prolonged exposure to harmful particles or gasses, usually from cigarette smoke. Smoking is the most common etiology of COPD worldwide, causing approximately 85 to 90% of all chronic obstructive pulmonary disease cases. Overall, 10% to 15% of smokers develop COPD. It should be noted that symptoms depend on the intensity of smoking, years of exposure, and baseline lung function. The more a person smokes, both in terms of years and volume of consumption (overall number of cigarettes), the greater the persons risk of COPD. This risk is not limited to cigarette smokers but applies to pipe smokers, cigar smokers, and marijuana smokers. […] Other possible causes of chronic obstructive pulmonary disease include: Secondhand smoke, Environmental and occupational exposures to air pollutants and chemicals chronic exposure to vapors, chemical fumes, and dusts can irritate and inflame the lungs, Alpha-1 antitrypsin deficiency (AATD) a genetic disorder that reduces the protective protein in the lungs.
- #2 Causes & symptoms of COPD | Canadian Lung Associationhttps://www.lung.ca/lung-health/lung-diseases/chronic-obstructive-pulmonary-disease-copd/causes-and-symptoms-copd
More than 2 million Canadians are living with COPD. There are estimates that up to a million more are living with COPD without knowing it. […] Smoking causes most but not all cases of COPD. It is estimated that about 15 to 20% of those who smoke will develop COPD, but only about 3 in 4 cases of COPD will occur in those who smoked. […] Other causes of COPD include: exposure to occupational dusts and chemicals, exposure to biomass smoke (for example, burning coal, wood or charcoal), exposure to second-hand smoke and inherited alpha-1 antitrypsin deficiency. Long-term exposure to air pollution, frequent lung infections as a child and poorly managed childhood asthma are also associated with an increased risk of COPD.
- #2 Chronic Obstructive Pulmonary Disease (COPD) FAQs | Temple Healthhttps://www.templehealth.org/services/conditions/chronic-obstructive-pulmonary-disease-COPD/faq
COPD is a chronic lung disease that is strongly linked to cigarette smoking. Other types of tobacco smoking including pipes, cigars and water pipes and smoking marijuana are also risk factors. […] Additional risk factors for COPD include exposure to second-hand smoke and air pollutants (air pollution, chemical fumes or dust), genetics/family history and advancing age. […] COPD is most commonly linked to smoking, but even non-smokers can get COPD. Risk factors for developing COPD include: Smoking cigarettes, Exposure to second-hand smoke or other lung irritants, such as smoke from a fire or fireplace, Long-term exposure to chemical fumes and agents, Asthma and chronic bronchitis, Recurrent respiratory infections, Genetic factors, Age and gender. […] Emphysema is caused by exposure to irritants such as tobacco smoke, air pollution or chemical fumes.
- #2 Causeshttps://www2.hse.ie/conditions/copd/copd-causes/
Chronic obstructive pulmonary disease (COPD) happens when the lungs and airways become damaged and inflamed. […] It’s usually associated with long-term exposure to something harmful such as cigarette smoke. […] Smoking is the main cause of COPD and is thought to be responsible for around 9 in every 10 cases. […] The harmful chemicals in smoke can damage the lining of the lungs and airways. […] Breathing in other people’s smoke (passive smoking) may increase your risk of COPD. […] Exposure to certain types of dust and chemicals at work may damage the lungs and increase your risk of COPD. […] The risk of COPD is even higher if you breathe in dust or fumes in the workplace and you also smoke. […] Exposure to air pollution over a long period can affect how well the lungs work. Some research has suggested it could increase your risk of COPD.
- #2 Chronic obstructive pulmonary disease\’s risk factorshttps://www.clinicbarcelona.org/en/assistance/diseases/chronic-obstructive-pulmonary-disease-copd/causes
Cigarette Inhalation of tobacco smoke. It is the principal cause of COPD. […] Passive smoker. There is consistently more risk to the passive smoker, especially during childhood. […] Genetic and environmental factors. COPD is an example of the interaction between genetic and environmental factors, as different genes probably contribute to the development of the disease. […] Biomass. In some countries it is used as domestic fuel. The continued use of this type of fuel in poorly ventilated homes could be a cause of COPD in non-smokers. […] Dusts (cereals, metallurgy) and chemical products (vapours, irritant substances and gases). In the work place they can cause COPD.
- #2 COPD causes – occupations and substances – HSEhttps://www.hse.gov.uk/copd/causes.htm
By far the main cause of COPD is smoking but research suggests occupational exposures are likely to play a role. […] HSE has looked at research and the following occupations are linked with a possible increased chance of getting COPD: […] A wide variety of dust or fume have the potential to cause COPD if exposure is high and over a long period of time, for example studies suggest the following substances have the potential to cause COPD;
- #2 COPD: Causes, Symptoms & Treatment | Live Sciencehttps://www.livescience.com/62616-copd-causes-symptoms-treatment.html
Chronic obstructive pulmonary disease (COPD) is a chronic lung disease that makes breathing progressively more difficult. […] COPD is caused by long-term exposure to irritating gases or particulate matter. In developed nations, the most common cause is cigarette smoke, though only about 20 to 30 percent of chronic smokers may develop clinically apparent COPD, according to the Mayo Clinic. […] In the developing world, exposure to fumes from burning fuel for cooking and heating in poorly ventilated homes is a common cause. A genetic disorder called alpha-1 antitrypsin deficiency can also cause COPD. This disorder is a lack of a protein called alpha-1 antitrypsin; the absence of this protein can damage the lungs. […] Other conditions that often contribute to COPD include emphysema (the destruction of alveoli by cigarette smoke, irritating gases and particulate matter) and chronic bronchitis (inflammation of the lining of the bronchial tubes), according to the Mayo Clinic.
- #2 Chronic obstructive pulmonary disease (COPD): MedlinePlus Medical EncyclopediaLockhttps://medlineplus.gov/ency/article/000091.htm
Chronic obstructive pulmonary disease (COPD) is a common lung disease. Having COPD makes it hard to breathe. […] Smoking is the main cause of COPD. The more a person smokes, the more likely that person will develop COPD. But some people smoke for years and never get COPD. […] If a person has a rare condition in which they lack a protein called alpha-1 antitrypsin, they can develop emphysema even without smoking. […] Other risk factors for COPD are: Exposure to certain gases or fumes in the workplace, Exposure to heavy amounts of secondhand smoke and pollution, Frequent use of a cooking fire without proper ventilation. […] Not smoking prevents most cases of COPD.
- #2 Causes and Risk Factors of COPDhttps://www.health.com/copd-causes-7094903
Up to 90% of COPD cases are linked to cigarette smoking. The more a person smokes, as well as the longer they smoke, can increase the risk and severity of the disease. […] Exposure to chemicals and fumes of harmful substances at work can damage the lungs and increase your risk of COPD. Long-term exposure to grain and flour dust, coal mine dust, welding fumes, silica, cadmium, and isocyanates (common in auto body paints and varnishes) have all been linked to COPD. […] Both indoor and outdoor pollutants can irritate airways and harm lung health. Smog (smoke and fog) is outdoor air pollution that contains many particles. Some of these particles can damage the lungs and airways and increase your chances of developing COPD. […] Having asthma as a child or as an adult is associated with a higher risk of COPD. Research has shown that people with asthma have a 12.5 times higher risk of the disease than those who do not. […] COPD occurs when damage from smoking or long-term exposure to harmful irritantsâchemical fumes, dust, and pollutionâcauses the airways to become inflamed and swollen, making it hard to breathe.
- #2 COPD – Causes and Risk Factors | NHLBI, NIHhttps://www.nhlbi.nih.gov/health/copd/causes
Cigarette smoking is the most common cause of COPD in the United States. Long-term smoking or breathing in tobacco smoke or pollutants in the air damages the lungs and airways. […] The following may raise your risk of COPD: […] Smoking: This is the main risk factor for COPD. Three out of four people who have COPD smoke or used to smoke. People who have a family history of COPD are more likely to develop the disease if they smoke. […] Other lung irritants: These may include long-term exposure to air pollution, chemical fumes and dust from the environment or workplace, smoke from home cooking and heating fuels without ventilation, and secondhand smoke, which is smoke in the air from other people smoking. […] Changes to lung growth and development: Conditions affecting the lungs when a baby is still in the uterus or during childhood can increase the risk. Examples include smoking in pregnancy or childhood asthma. Air pollution can also limit the growth of a child’s lungs and increase their risk of developing COPD. […] A condition that runs in families, called alpha-1 antitrypsin (AAT) deficiency: If you are born with this condition, smoking or long-term exposure to fumes or dust can lead to lung damage and COPD. AAT deficiency can also raise your risk for developing COPD at a younger age.
- #2 COPD Causes: Smoking & 7 Other Things That May Cause COPDhttps://www.webmd.com/lung/copd/what-causes-copd
Asthma: Poorly controlled asthma can raise the risk for developing COPD. […] Things that can make you more likely to get COPD include: […] Smoking: This is the most common cause of COPD. […] Asthma: Your chances are even higher if you have asthma and you smoke. […] Age: Most people are 40 or older when their symptoms start up. […] Certain jobs: If your job puts you around dust, chemical fumes, or vapors, your lungs can get damaged. Damage can also come from prolonged exposure to air pollution. […] Infections: If you had lots of respiratory infections in childhood, you have a greater chance of COPD in adulthood.
- #2 COPD Causes and Risk Factors | American Lung Associationhttps://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/what-causes-copd
While these causes and risk factors may increase your risk of developing COPD, people living in poverty and people living in rural areas are more likely to develop COPD. Beyond smoking status, some reasons for the increased risk of developing COPD may include exposures to indoor and outdoor pollutants, occupational exposures and lack of access to healthcare.
- #2 The etiologic origins for chronic obstructive pulmonary disease | COPDhttps://www.dovepress.com/the-etiologic-origins-for-chronic-obstructive-pulmonary-disease-peer-reviewed-fulltext-article-COPD
The early abnormal lung development including airway and alveolar development might underlie the susceptibility to COPD and impaired lung function. […] The interaction of ADAM33 with prenatal smoking exposure could lead to reduced lung function and development of asthma at the age of 8. […] Many GWAS-identified COPD genes play key roles in lung development and lung injury-repair response, and their abnormal expression modulated by variation or disturbance of maternal environmental exposure before the birth of individuals may pave the way for COPD development and poor lung function. […] Maternal amniotic fluid has important impacts on fetal lung development and respiratory disease occurrence in offspring. […] Fetal exposure to maternal smoking during pregnancy is one of the most serious events for abnormal lung development, it can increase the risk of poor lung function, COPD, asthma, and childhood wheeze.
- #2 Mechanisms, Pathophysiology and Currently Proposed Treatments of Chronic Obstructive Pulmonary Diseasehttps://www.mdpi.com/1424-8247/14/10/979
Chronic obstructive pulmonary disease (COPD) is one of the leading global causes of morbidity and mortality. A hallmark of COPD is progressive airflow obstruction primarily caused by cigarette smoke (CS). […] Tobacco smoking and inhalation of other pollutants are the leading causes of COPD. […] The prevalence and burden of COPD will increase in the coming decades due to continued exposure to risk factors and aging of the world population. […] The pathogenesis of emphysema includes destruction of alveolar septa, increased air space, and loss of elastic recoil due to hyperinflammation and oxidative stress. […] The breakdown of elastic fibers, so-called elastolysis, is one of the hallmarks of emphysema, an important phenotype contributing to COPD. […] COPD is characterized by progressive airflow limitation that is not fully reversible, associated with an abnormal inflammatory response of the lungs to noxious particles or gases.
- #2 Chronic Obstructive Pulmonary Disease (COPD) FAQs | Temple Healthhttps://www.templehealth.org/services/conditions/chronic-obstructive-pulmonary-disease-COPD/faq
COPD is a preventable disease in most patients. The best way to prevent COPD is to quit smoking or never smoke. If you’ve tried to quit smoking before, consider joining our Smoking Cessation Program. […] Also, try to avoid long-term exposure to lung irritants such as air pollution, chemicals, dust and second-hand smoke.
- #2 Pathogenesis of chronic obstructive pulmonary disease (COPD) induced by cigarette smoke – Hikichi – Journal of Thoracic Diseasehttps://jtd.amegroups.org/article/view/32744/html
The relationship between autophagy and programmed necrosis (necroptosis) involved in CS-induced cell death is a novel finding that reveals the mechanism of exaggerated inflammatory response that is not explained by apoptosis-derived cell death. […] COPD is a complex disease with various molecular pathogenic mechanisms. A comprehensive understanding of the heterogeneity in COPD and its etiology is required in the clinical setting.
- #3 Mechanisms, Pathophysiology and Currently Proposed Treatments of Chronic Obstructive Pulmonary Diseasehttps://www.mdpi.com/1424-8247/14/10/979
The imbalance between proteases and their inhibitors plays a crucial role in COPD pathogenesis. […] Cigarette smoke (CS) is the primary source of oxidant agents in the lungs, but inflammatory cells and phagocytes residing in the respiratory tract also generate reactive oxygen species (ROS) in the lungs. […] Oxidative stress is the primary cause of COPD pathogenesis, triggering apoptosis, extracellular matrix remodeling, inactivation of protease inhibitors, mucus secretion, NF-κB activation, mitogen-activated protein kinase (MAPK) activation, chromatin remodeling, and pro-inflammatory gene transcription. […] The increase in elastolytic enzymes, such as MMPs, induces ECM degradation and alveolar wall destruction. […] COPD presents a high mortality rate because it causes organ damage and alters lung function. An imbalance between oxidants and antioxidants is a primary characteristic of COPD.