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Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term, which encompasses chronic bronchitis and emphysema. These conditions often co-exist and are characterised by largely irreversible airflow obstruction, hypertrophy of mucus secreting glands and hyperinflation due to loss of lung elastic recoil. Patients typically present with progressive breathlessness, chronic productive cough and recurrent chest infections.
Tobacco smoking is the primary preventable risk factor for COPD; inhalation of toxic particles and gases cause a chronic inflammatory response in the airways and lung parenchyma. This causes structural changes, with narrowing of the small airways and destruction of the alveolar and capillary membranes, resulting in small airway collapse and air trapping.
There are other recognised risk factors including exposure to other noxious particles such as smoke from biomass fuels, smoking recreational drugs, organic and inorganic dusts, chemical agents and fumes. Additionally, genetic and environmental factors may affect an individual’s susceptibility to the damaging effect of smoking on the lungs; Alpha-1 antitrypsin deficiency is an inherited form of emphysema, in which a lack of the protective Alpha-1 antitrypsin protein results in early and more rapidly progressive lung damage in response to smoking.
Tobacco smoke remains the single greatest contributing factor to the development of COPD and it is recognised that there is a cumulative risk, with prevalence increasing with age and degree of exposure.