More than half manifests a productive cough and half of the cases passed the Global Initiative for Chronic Obstructive Lung Disease criteria for emphysema. Age, gender, race, smoking history, blood type, alpha1-antitrypsin variation, socioeconomic status, occupation, pollution exposure, and infections are the known risk factors for developing COPD. The race is also a factor in developing COPD, wherein whites have an odds ratio of 3.1 in dying from this condition (Meyer et al, 2002) though African Americans appear to be more susceptible to the effects of COPD than whites (Chatila et al, 2004).
Among those risk factors, smoking is the most prominent cause of COPD. According to the World Health Organization (WHO), 40% to 74% who die from COPD are smokers (Mannino & Buist, 2007). Meyer et al (2002) reveal more than 80% of deaths from those who experienced smoking before and during COPD morbidity, while the odds ratio of those who currently smoke versus those who stopped smoking are 6.5 and 3. Aside from irritants from smoking, occupational-related vapors, gas, dust, and fumes exposure is also a risk in developing COPD (Blanc et al, 2009).
The numerous irritants, either from cigarette smoke or from environmental pollution, stimulate inflammatory response along the bronchi and the alveoli. The COPD-related effects of this response are increased mucus production and the release of protease and elastase, enzymes that can damage the lung’ s connective tissues. Without adequate alpha1-antitrypsin to counteract the effects of these enzymes, tissue destruction will be progressive. This destruction collapses the alveoli, allowing air pockets to form between the alveolar spaces. The elasticity of the alveolar walls is also altered, making expiration more difficult.
These air pockets increase the lung area that cannot facilitate gas and blood exchange, thus this is where the manifestations of emphysema set in. As the gas exchange is altered, oxygen and carbon dioxide are not effectively exchanged. With decreasing oxygen concentration while increasing carbon dioxide concentration in the blood, increase in respiratory effort is stimulated, resulting in progressive dyspnea.
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