Inflammation and Treatment in Asthma and COPD

By James F. Donohue, MD, FCCP; and Jill A. Ohar, MD, FCCP

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COPD

Significance

COPD represents a disease state characterized by poorly reversible airflow limitation that is usually both progressive and associated with an abnormal inflammatory response of the lung.⁴ It is a disorder largely caused by the inhalation of tobacco smoke. Other risk factors include environmental exposures such as coal, asbestos, or indoor air pollution. Genetic predisposition, childhood respiratory tract infections, and low birth weight are also factors that influence the development of COPD. COPD is by definition a progressive disorder. Healthy nonsmokers > 30 years of age lose FEV₁ at a rate of 20 mL/yr, but the age-related loss of FEV₁ in smokers with COPD is accelerated.¹⁰ No currently available COPD therapy except oxygen and smoking cessation changes the rate of FEV₁ loss. While 80 to 90% of the burden of COPD is caused by cigarette smoking, only 15 to 20% of smokers develop COPD. COPD is currently the fourth leading cause of death in the United States and the only disease among the top 10 causes of death that is increasing in prevalence. The World Health Organization predicts that COPD will be the third leading cause of death worldwide within the next two decades.⁴ Despite these startling statistics, tobacco consumption rates are on the rise worldwide, which will result in new cases of COPD for decades to come.

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