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What increases my risk for chronic obstructive pulmonary disease (COPD)?

Cigarette smoking is the number one risk factor for chronic obstructive pulmonary disease (COPD). While smoking causes almost all COPD cases, not all smokers develop COPD. This risk increases with age, partially related to the number of years of cigarette smoking.

Smoking more exotic forms of tobacco, such as that used in Chinese water pipes (hookahs), can be even more harmful. In some cases, these can increase your risk more than traditional cigarettes. Research also suggests that people who are chronically exposed to secondhand smoke (in any form) have an increased risk of developing COPD.

Genetics may play a role in a form of emphysema that is more common in people of northern European descent. People with this form of COPD have a hereditary deficiency of a blood component known as alpha-1-antitrypsin (AAT). People with this defect can develop COPD by early middle age. If you have close relatives who developed COPD in their 30s or 40s, your risk of this type of COPD may be elevated. A deficiency of AAT can be detected by blood tests available at medical laboratories.

Finally, chronic exposure to dust, gases, chemicals and biomass fuels increases your risk of developing or exacerbating COPD. These include smoke from burning wood, charcoal and crop residue. Exposure to these can also worsen symptoms of the disease.

Anyone who was had a significant smoking history would be a candidate for chronic obstructive pulmonary disease (COPD) testing. A significant history would be people who have smoked consistently for more than about five years, or people who have smoked at any point or been around secondhand smoke and have concerns about their breathing.

Other things can cause COPD, including some diseases that run in families, and your body's responsiveness (meaning if your body tends to overreact) to allergens or pollutants in the air. Your doctor will decide which tests are appropriate—it is best to be examined early if you are having trouble breathing.

The risk of chronic obstructive pulmonary disease (COPD) increases mostly because of inhaling substances that damage the lungs. COPD most often occurs in people over the age of 40 who have a history of smoking. This is because smoking directly damages the lining of the airways. Not all smokers get chronic obstructive pulmonary disease (COPD), but the majority of those with COPD have smoked.

Breathing in other people’s smoke can also cause COPD. COPD can happen too in people who have been exposed for a long time to harmful pollutants, like chemicals, dust and fumes at work. Rarely, COPD can happen in non-smokers and in those not exposed to pollutants.

Most cases of chronic obstructive pulmonary disease (COPD) are caused by inhaling pollutant. That includes smoking (cigarettes, pipes, cigars, etc.) and secondhand smoke. Fumes, chemicals and dust found in many work environments are contributing factors for many individuals who develop COPD. Genetics can also play a role in an individual’s development of COPD—even if the person has never smoked or been exposed to strong lung irritants in the workplace.

The top three risk factors for developing COPD are:

  • Smoking: COPD most often occurs in people 40 years of age and older who have a history of smoking. These may be individuals who are current or former smokers. While not everybody who smokes gets COPD, most of the individuals who have COPD (about 90 percent of them) have smoked.
  • Environmental factors: COPD can also occur in those who have had long-term contact with harmful pollutants in the workplace. Some of these harmful lung irritants include certain chemicals, dust or fumes. Heavy or long-term contact with secondhand smoke or other lung irritants in the home, such as organic cooking fuel, may also cause COPD.
  • Genetic factors: Even if an individual has never smoked or been exposed to pollutants for an extended period of time, they can still develop COPD. Alpha-1 antitrypsin deficiency (AATD) is the most commonly known genetic risk factor for emphysema 2. Alpha-1 antitrypsin-related COPD is caused by a deficiency of the alpha-1 antitrypsin protein in the bloodstream. Without the alpha-1 antitrypsin protein, white blood cells begin to harm the lungs and lung deterioration occurs. The World Health Organization and the American Thoracic Society recommend that every individual diagnosed with COPD be tested for alpha-1.

A person may have chronic obstructive pulmonary disease (COPD) but not notice symptoms until it is in the moderate stage. This is why it’s important to ask your doctor about taking a breathing test (called spirometry) if you are a current or former smoker, have been exposed to harmful lung irritants for a long period of time or have a history of COPD in your family, such as alpha-1 antitrypsin deficiency-related COPD.

If you have any of the following symptoms, you are at risk for developing COPD:

  • chronic coughing with or without sputum
  • wheezing
  • shortness of breath that has become worse over time
  • cannot keep up with people of your own age

Risk factors for chronic obstructive respiratory diseases (COPD) include:

  • Smoking. COPD is more than four times as prevalent among smokers as among nonsmokers, affecting about 14 percent of smokers and just 3 percent of the latter. In addition, smokers are 10 times more likely to die from COPD. An intriguing question is why even more smokers don't get COPD. The fact that a relatively small percentage of smokers is affected strongly suggests that there are genetic factors that influence which smokers develop the condition and which don't.
  • Genetics. Alpha-1-antitrypsin (A1AT) deficiency is an inherited condition involving a defect in the gene that controls the production of A1AT, the protein that neutralizes an enzyme that degrades lung tissue. When the gene is defective, the level of A1AT is about 15 percent of normal, giving the enzyme free rein to wreak havoc on the lungs. In all, A1AT deficiency causes 3 percent of cases of emphysema. Smokers who have the genetic defect are almost certain to get emphysema.

Long term cigarette smoking is the primary cause of chronic obstructive pulmonary disease (COPD). The longer you smoke and the more packs you smoke, the greater your risk for developing COPD. Secondhand smoke, air pollution and some chemical fumes can also lead to COPD. In some cases, a severe form of acid reflux disease, gastroesophageal reflux disease, may cause COPD. While extremely rare, a genetic disorder known as alpha1-antitrypsin deficiency can also cause COPD.

Dr. Audrey K. Chun, MD
Geriatric Medicine Specialist

The great majority of patients with chronic obstructive pulmonary disease (COPD) develop their disease as a result of smoking. Continuing to smoke after being diagnosed with COPD puts you at risk of faster deterioration in lung function. Quitting the habit is imperative for preserving your remaining lung function.

Acute exposure of several days to high-level air pollution is also known to be a risk factor for exacerbation in pre-existing chronic obstructive pulmonary disease (COPD). A study published online in the American Journal of Respiratory and Critical Care Medicine suggests that long-term exposure to low levels of air pollution may increase the risk of developing COPD.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.