RISK FACTORS FOR THE DEVELOPMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

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CIGARETTE SMOKING AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

In the 1950s, the most widely advanced hypothesis for the cause of COPD linked progressive lung damage to air pollution and recurrent respiratory infections. By 1964, adequate epidemiologic evidence had accumulated for the Advisory Committee to the Surgeon General to conclude that: "Cigarette smoking is the most important of the causes of chronic bronchitis in the United States, and increases the risk of dying from chronic bronchitis and emphysema.74 Nearly all of the studies on which the 1964

AIRWAY RESPONSIVENESS AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

An increased tendency for bronchial constriction in response to a variety of exogenous stimuli, including methacholine and histamine, is one of the defining features of asthma. Many subjects with COPD, however, also share this feature of airway hyperresponsiveness. The considerable overlap between subjects with asthma and COPD in airway responsiveness; airflow obstruction; and pulmonary symptoms such as cough, phlegm, and wheezing led to the formulation of the Dutch hypothesis in 1961.55 This

Alpha1-Antitrypsin Deficiency and Chronic Obstructive Pulmonary Disease

Alpha1-antitrypsin, specified by the protease inhibitor (PI) locus, is the major serum protease inhibitor of human leukocyte elastase, a serine protease generally considered to be one of the major destructive enzymes in the development of pulmonary emphysema.33, 73 More than 75 different PI alleles have been identified, a few of which result in decreased serum levels of alpha1-antitrypsin.4 The common M allele, with an allele frequency greater than 95% in U.S. populations, is associated with

Respiratory Infections

A variety of other environmental risk factors also have been studied as potential contributors to the development of COPD. Respiratory infections have been studied as a potential risk factor for the development and progression of COPD in adults; childhood respiratory infections also have been assessed as a potential predisposing factor to the eventual development of COPD. A challenging problem in assessing the importance of respiratory infections as a risk factor for COPD is determining whether

SUMMARY

Cigarette smoking clearly has been shown to be the major environmental risk factor predisposing to the development of COPD. Occupational exposures to dust and fumes, air pollution, passive smoke exposure, childhood respiratory infections, and diet may also contribute. Airway hyperresponsiveness is a risk factor for the development of decline in FEV1 but its role in the development of COPD remains uncertain. Alpha1-antitrypsin deficiency is an important genetic risk factor for COPD in the small

ACKNOWLEDGMENTS

The authors appreciate the useful comments provided by Dr. Scott Weiss, Dr. Edward Campbell, and Dr. Ira Tager.

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