Chronic Obstructive Pulmonary Disease (COPD)


Relationship Between Various Obstructive Lung Diseases

  • Key Points
    • Classical Obstructive Lung Diseases, Such as Chronic Obstructive Pulmonary Disease and Asthma, May or May Not Demonstrate Obstruction
    • Obstruction (with Wheezing, etc) Can Also Be Variably Present in Other Airway and Lung Diseases



  • COPD is the 3rd Leading Cause of Death in the US (2009 Data)
    • COPD Accounted for 133,965 Deaths in 2009
  • 2011 Data: approximately 12.7 million adults in the US had COPD
    • Approximately 24 Million US Adults Have Evidence of Impaired Lung Function: suggests that COPD is underdiagnosed


  • COPD-Related Health Care Utilization (2009 Data)
    • 8 Million Office Visits
    • 1.5 Million Emergency Department Visits
    • 715,000 Hospitalizations
  • Costs Due to COPD
    • Approximately $49.9 billion: $29.5 billion in direct health-care expenditures, $8.0 billion in indirect morbidity costs, and $12.4 billion in indirect mortality costs
  • COPD Exacerbations Account for Most of the Morbidity, Mortality, and Costs Associated with COPD
    • COPD Exacerbations Cause Frequent Hospital Admissions/Relapses/Readmissions, Contribute to Death During Hospitalization or Shortly Thereafter, Significantly Decrease Quality of Life, Expend Financial Resources, and Accelerate a Progressive Decline in Pulmonary Function

Risk Factors for Chronic Obstructive Pulmonary Disease (COPD)

Tobacco Use (see Tobacco, [[Tobacco]])

  • xxxx

Environmental Pollutants

  • Indoor Air Pollution: biomass cooking and heating in poorly-ventilated structures are important risk factors for COPD
  • Outdoor Air Pollution: probably a small contributor, in comparison to tobacco smoke

Alpha-1 Antitrypsin Deficiency (see Alpha-1 Antitrypsin Deficiency, [[Alpha-1 Antitrypsin Deficiency]])

  • xxx

Asthma/Bronchial Hyperreactivity (see Asthma, [[Asthma]])

  • Epidemiology: may be risk factors for COPD

Dust (Organic and Inorganic)

  • xxx

Genetic Factors

  • Alpha-1 Antitrypsin
  • Matrix Metalloproteinase 12 (MMP12)


  • Epidemiology: unclear risk factor for COPD
    • Human Immunodeficiency Virus (HIV) (see Human Immunodeficiency Virus, [[Human Immunodeficiency Virus]])
      • HIV Infection Accelerates the Onset of Smoking-Related Emphysema (see Human Immunodeficiency Virus, [[Human Immunodeficiency Virus]])
      • In a Population-Based Study Using Ontario’s Health Administration Database of Patients Diagnosed with COPD Between 1996-2015, the Rate of COPD was Higher in HIV-Positive Patients, as Compared to HIV-Negative Patients (10.4 vs 9.0 Cases Per 1000 Person-Years; Standardized Incidence ratio 1.16, 95% Confidence Interval 1.10 to 1.21; Adjusted Rate Ratio 1.34, 95% CI 1.27 to 1.41) (CMAJ Open, 2020) [MEDLINE]
        • In a Sensitivity Analysis, Smoking Explained the Observed Differences in COPD Incidence

Inflammatory Bowel Disease (IBD) (see Inflammatory Bowel Disease, [[Inflammatory Bowel Disease]]): chronic bronchitis is associated with UC

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Positive Family History of COPD (Chest, 2011) [MEDLINE]

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  • Clearly a risk factor for COPD, but exact contributors are unclearB


  • Chronic Hydrocarbon Inhalant Abuse (see Hydrocarbons): associated with panacinar emphysema