The pathogenesis and pathology of COPD: Identifying risk factors and improving morbidity and mortality

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.