Risk factors for the development of chronic obstructive pulmonary disease.

Channing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Medical Clinics of North America (Impact Factor: 2.8). 06/1996; 80(3):501-22. DOI: 10.1016/S0025-7125(05)70451-X
Source: PubMed

ABSTRACT 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 minority of COPD patients who inherit this deficiency. Other genetic factors are likely involved but have not yet been identified. Elucidation of additional genetic risk factors may provide useful insights into the pathogenesis of COPD. Potential interactions between the various environmental and genetic risk factors may be extremely important in determining the variable development of COPD.

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    • "Results of all epidemiological studies prove that the prevalence of respiratory symptoms is higher in smokers than in non-smokers, and that COPD prevalence increases with age (Silverman and Speizer 1996). Other factors responsible for the high prevalence and incidence of COPD are the increasing mean age of populations together with persistent and ever increasing environmental pollution (Silverman and Speizer 1996; Murray and Lopez 1997; Viegi et al 2001). COPD is the fourth leading cause of death (Murray and Lopez 1997; WHO 1998) and one of the main causes of disability in the world, particularly in developed countries. "
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    ABSTRACT: Attention to COPD is increasing worldwide because its high prevalence, morbidity, and mortality present a challenging problem for all healthcare systems. The burden of COPD, which is usually measured in terms of progressive lung function decline, impact on patients' symptoms, patient's disability, and quality of life, together with the corresponding use of health care resources, is still a major aspect of the disease. Recommendations to treat COPD according to the most accepted guidelines have expanded in recent years even though COPD still remains unacceptably under-diagnosed and under-treated worldwide. Obviously, more severe degrees of COPD receive major attention both in terms of monitoring of clinical outcomes and of assessing the economic value of therapeutic interventions. The role of different strategies against COPD should be valued on the basis of their effectiveness in outcome optimization, which primarily depends on the efficacy of prevention activities and of early diagnosis programs. It is generally agreed that the main proportion of COPD burden still depends on the clinically uncontrolled disease and on its high exacerbation rate, which frequently leads to the patient hospitalization. In COPD, the effects of guideline recommendations have been only sporadically investigated in pharmaoeconomic terms, even though symptoms and disability have declined substantially; the corresponding improvement in quality of life, and a significant decrease in both direct and indirect costs have been proved to depend on appropriate rehabilitative and pharmacological long-term treatment of the disease. At present, more precise indices and more fitting outcomes are continuously sought and found in order to assess more effective strategies for controlling COPD.
    International Journal of COPD 02/2008; 3(1):1-10. · 2.73 Impact Factor
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    • "Tobacco smoking is the main risk factor for COPD but despite this only a fraction of smokers go on to develop the disease (Barnes 2000). While it has been suggested that susceptibility to tobacco smoke may refl ect a genetic component of the disease (Barnes 1999) the only genetic factor identifi ed so far in predisposing individuals to COPD is the α 1 -antitrypsin defi ciency (Silverman and Speizer 1996). The Angiotensin-converting enzyme (ACE) is a zinc metallo-peptidase that is highly expressed in lungs, where it degrades bradykinin and catalyses the formation of the Angiotensin II (AII); a powerful vasoconstrictor, infl ammatory modulator and cellular growth factor (Woods et al 2000). "
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    ABSTRACT: While tobacco smoking is the main risk factor for chronic obstructive pulmonary disease (COPD) only a fraction of smokers go on to develop the disease. We investigated the relationship between the insertion (I)--deletion (D) polymorphisms in the Angiotensin converting enzyme (ACE) gene and the risk of developing COPD in smokers by determining the distribution of the ACE genotypes (DD, ID and II) in 151 life-long male smokers. 74 of the smokers had developed COPD (62 +/- 2 years; FEV1 44 +/- 6% reference) whereas the rest retained normal lung function (56 +/- 2 yrs; FEV1 95 +/- 3% reference). In addition, we genotyped 159 males recruited randomly from the general population. The prevalence of the DD genotype was highest (p = 0.01) in the smokers that developed COPD and its presence was associated with a 2-fold increase in the risk for COPD (OR 2.2; IC95% 1.1 to 5.5). Surprisingly, the 151 individuals in the smoking population did not demonstrate Hardy-Weinberg equilibrium unlike the 159 recruited from the general population. Our results suggest that ACE polymorphisms are associated with both the smoking history of an individual and their risk of developing COPD.
    International Journal of COPD 02/2007; 2(3):329-34. · 2.73 Impact Factor
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    • "To recommend spirometry routinely on medical check-up, we need to identify the prevalence of COPD in people not aware of this disease. COPD is affected by several factors such as sex (Thom 1989; National Institutes of Health, National Heart, Lung, and Blood Institute 2001), age (Viegi 2001), smoking (Silverman and Speizer 1996), and occupation (Hnizdo et al. 2002; Marget et al. 2002). In particular, COPD is strongly associated with smoking and was thought to be the leading cause of death attributable to smoking in the world in 2000 (Ezzati and Lopez 2003). "
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    ABSTRACT: In Japan, spirometry has not been included as an item in medical check-ups for all persons. The purpose of this study was to show evidence to recommend spirometry routinely on medical check-up for the early detection of chronic obstructive pulmonary disease (COPD). There were 12,760 enrolled persons who underwent medical check-up. COPD was defined as a ratio of forced expiratory volume in one second to slow vital capacity of 70% or less. We investigated the prevalence and its characteristics of COPD in people on medical check-up. The prevalence of COPD was 3.6% in all subjects, 4.5% in males, and 1.8% in females. In the comparison between males and females, the prevalence of COPD in males of most age groups was higher than that of females, and this difference was greater with aging. Males in their 50s and over 60 years old and females over 60 years old showed remarkably high prevalences. Occupations associated with a high smoking rate such as transportation-related occupations showed a higher prevalence of COPD. These results suggest that spirometry for all persons in medical check-ups can identify many COPD patients not aware of this disease. Spirometry should be carried out routinely on medical check-up.
    The Tohoku Journal of Experimental Medicine 10/2005; 207(1):41-50. DOI:10.1620/tjem.207.41 · 1.28 Impact Factor