What causes emphysema other than smoking? What are the risk factors for COPD? How does COPD affect the lungs? Get answers to these questions and learn tips to help prevent COPD.

Smoking: The Primary Cause of COPD

Cigarette smoke is by far the most common cause of chronic obstructive pulmonary disease (COPD), which includes emphysema. Smoking accounts for around 9 out of 10 COPD cases. The harmful chemicals in smoke can damage the lining of the lungs and airways, leading to this chronic lung condition. Even secondhand smoke exposure can increase the risk of developing COPD.

Other Causes of COPD

While smoking is the primary cause, there are other factors that can contribute to COPD:

• Fumes and Dust at Work: Prolonged exposure to certain types of dust, chemicals, and other airborne pollutants in the workplace can also damage the lungs and increase the risk of COPD.
• Genetic Factors: In rare cases, people may have a genetic defect called alpha-1 antitrypsin (AAT) deficiency that leads to severe COPD, even in non-smokers.
• Asthma: Poorly controlled asthma can raise the risk of developing COPD.
• Respiratory Infections: Frequent respiratory infections in childhood can increase the chances of COPD in adulthood.
• Air Pollution: Exposure to air pollution, both outdoors and indoors, can contribute to COPD.

Who is at Greater Risk of COPD?

In addition to the causes mentioned, certain factors can make someone more susceptible to COPD:

• Smoking: Smokers have a much higher risk of developing COPD compared to non-smokers.
• Asthma: People with asthma, especially if they also smoke, have an even greater chance of getting COPD.
• Age: Most people develop COPD symptoms after the age of 40.
• Occupational Exposure: Jobs that involve exposure to dust, chemicals, or other airborne pollutants can increase the risk of COPD.
• Childhood Respiratory Infections: Frequent respiratory infections during childhood may contribute to COPD later in life.

How COPD Affects the Lungs

In a healthy lung, tiny air sacs called alveoli fill up like balloons with each breath, allowing oxygen to pass into the bloodstream and carbon dioxide to be expelled. With COPD, the walls between these alveoli break down, and the airways become swollen and clogged with mucus. This makes it harder for the lungs to efficiently exchange oxygen and carbon dioxide, leading to breathing difficulties.

Preventing and Slowing COPD Progression

While the lung damage caused by COPD cannot be reversed, there are steps you can take to prevent or slow its progression:

• Don’t Smoke: Quitting smoking is the single most important thing you can do to prevent or slow down COPD.
• Avoid Lung Irritants: Steer clear of fumes, dusts, secondhand smoke, and other air pollutants that can further damage your lungs.
• Get Vaccinated: Protect your lungs by getting vaccinated against the flu and pneumonia.
• Seek Testing for AAT Deficiency: If you have unexplained lung problems, especially at a young age, ask your doctor about getting tested for the rare genetic condition alpha-1 antitrypsin (AAT) deficiency.
• Manage Respiratory Infections: Colds, flu, and other respiratory infections can worsen COPD, so be vigilant about handwashing and avoiding sick contacts.

Treatments and Lifestyle Changes for COPD

While the damage to the lungs cannot be reversed, there are treatments and lifestyle changes that can help manage COPD symptoms and slow the progression of the disease:

• Medications: Bronchodilators, inhaled corticosteroids, and other medications can help open the airways and reduce inflammation.
• Oxygen Therapy: Supplemental oxygen can improve oxygen levels in the blood for those with severe COPD.
• Pulmonary Rehabilitation: Exercise programs and education can help improve fitness and quality of life for those with COPD.
• Lifestyle Adjustments: Quitting smoking, maintaining a healthy diet, and avoiding lung irritants are crucial for managing COPD.

Seeking Medical Attention for COPD

If you experience persistent shortness of breath, frequent coughing, or other respiratory symptoms, it’s important to see your doctor. They can perform lung function tests to diagnose COPD and develop an appropriate treatment plan. Early intervention is key for managing this chronic lung condition and preventing further deterioration.

Smoking & 7 Other Things That May Cause COPD

Written by R. Morgan Griffin

• Common Causes of COPD
• Risk Factors for COPD
• How Does COPD Affect My Lungs?
• Tips to Help Prevent COPD

Chronic obstructive pulmonary disease, or COPD, is an ongoing lung disorder that makes it hard to breathe.

The main cause of COPD is smoking, but you don’t have to be a smoker to get it. Other things can lead to this condition, which leaves you feeling short of breath.

Learn more about what causes it, who has the greater odds of getting it, and how you can lower your chances.

COPD is most likely to result from:

• Cigarette smoke: This is by far the most common reason people get COPD. You can also get it from tobacco products, such as cigar and pipe smoke, especially if you breathe in the smoke.
• Secondhand smoke: Even if you aren’t a smoker, you can get COPD from living with one.
• Pollution and fumes: You can get COPD from air pollution. Breathing in chemical fumes, dust, or toxic substances at work can also cause it.
• Your genes: In rare cases, people with COPD have a defect in their DNA, the code that tells your body how to work properly. This defect is called “alpha-1 antitrypsin deficiency,” or AAT deficiency. When you have this, your lungs don’t have enough of a protein needed to protect them from damage. This can lead to severe COPD. If you or a family member had serious lung problems — especially at a young age — ask your doctor about testing for AAT deficiency.
• Asthma: Poorly controlled asthma can raise the risk for developing COPD.

Things that can make you more likely to get COPD include:

• Smoking: This is the most common cause of COPD.
• Asthma: Your chances are even higher if you have asthma and you smoke.
• Age: Most people are 40 or older when their symptoms start up.
• Certain jobs: If your job puts you around dust, chemical fumes, or vapors, your lungs can get damaged. Damage can also come from prolonged exposure to air pollution.
• Infections: If you had lots of respiratory infections in childhood, you have a greater chance of COPD in adulthood.

Inside your lungs are tiny sacs called alveoli. They fill up like balloons every time you take a breath. The oxygen in these sacs passes into your bloodstream, and then your lungs push out the stale air.

When you have COPD, your lungs don’t work as they should. Long-term irritation from smoke or other pollutants can damage them for good.

When this happens, the walls between the alveoli break down. Your airways get swollen and clogged with mucus. It becomes harder to push out the stale air. You don’t get enough fresh oxygen with each breath.

In most cases, this happens very slowly. The symptoms may come on over time. It may be years before you even notice them.

You can’t heal the damage that has already happened in your lungs. But you can make changes to slow down the damage or stop it from getting worse.

1. Don’t smoke. This is the best way to prevent COPD or slow it down if you already have it. If you don’t smoke, don’t start. If you smoke, quit. Ask your doctor, family, and friends to help.
2. Avoid breathing in things that bother your lungs. As much as possible, stay away from fumes, toxins, secondhand smoke, and dust.
3. Watch out for colds, viruses, and infections. If you have COPD, even a common cold can lead to severe problems. During cold season, wash your hands well and often. Use hand sanitizer if you cannot wash your hands. Try not to be around people who are sick.
4. Get vaccines. Protect your lungs against the flu and pneumonia.
5. Ask your doctor about being tested for AAT deficiency. A blood test can find this type of COPD that you get from your parents at birth. It isn’t common, but if you have serious lung symptoms with no clear cause like smoking, your doctor may check. You may also need testing if you get emphysema (a type of COPD) before age 46 or have a family member with AAT deficiency. Medicines as well as other treatments and lifestyle changes can keep you breathing easier if you do have COPD.

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Chronic obstructive pulmonary disease (COPD) – Causes

Chronic obstructive pulmonary disease (COPD) happens when the lungs and airways become damaged and inflamed.

It’s usually associated with long-term exposure to harmful substances such as cigarette smoke.

Things that can increase your risk of developing COPD are discussed in this section.

Smoking

Smoking is the main cause of COPD and is thought to be responsible for around 9 in every 10 cases.

The harmful chemicals in smoke can damage the lining of the lungs and airways. Stopping smoking can help prevent COPD from getting worse.

Some research also suggests that being exposed to other people’s cigarette smoke (passive smoking) may increase your risk of COPD.

Fumes and dust at work

Exposure to certain types of dust and chemicals at work may damage the lungs and increase your risk of COPD.

Substances that have been linked to COPD include:

• cadmium dust and fumes
• grain and flour dust
• silica dust
• welding fumes
• isocyanates
• coal dust

The risk of COPD is even higher if you breathe in dust or fumes in the workplace and you smoke.

The Health and Safety Executive has more information about occupational causes of COPD

Air pollution

Exposure to air pollution over a long period can affect how well the lungs work and some research suggests it could increase your risk of COPD.

But the link between air pollution and COPD is not conclusive and research is continuing.

Genetics

You’re more likely to develop COPD if you smoke and have a close relative with the condition, which suggests some people’s genes might make them more vulnerable to the condition.

People with alpha-1-antitrypsin deficiency can go on to develop COPD. Alpha-1-antitrypsin is a substance that protects your lungs. Without it, the lungs are more vulnerable to damage.

People who have an alpha-1-antitrypsin deficiency usually develop COPD at a younger age – particularly if they smoke.

Asthma + Lung UK has more information about alpha-1-antitrypsin deficiency

Alpha-1 UK Support Group is for people affected by alpha-1-antitrypsin deficiency

Page last reviewed: 11 April 2023
Next review due: 11 April 2026

what is it and how to treat. The role of smoking

Figures presented during World No Tobacco Day, an annual event dedicated to raising awareness of the importance of quitting, show that almost one in four Italians (1% of the population) will smoke in 2022: a percentage increase of 4 percentage points item. compared with the pre-pandemic period from 24.2

Smoking is now well known to be an important (if not the main) risk factor for the development of many diseases (eg cancer).

These include lung emphysema.

It is estimated that it affects about 210 million people worldwide and can cause 3 million deaths each year.

In the past, emphysema was more common in men who were heavy smokers.

However, in recent years, the scenario has changed: even female smokers, who are now more numerous than in the past, suffer from emphysema and at the same time, much more often than men, also have chronic obstructive bronchopathy, a disease associated with emphysema, as we shall see. below.

Early intervention, especially to prevent a decline in lung function, is not only possible but necessary.

What is pulmonary emphysema and its types

Emphysema is a disease of the pulmonary alveoli: the tissue they are composed of degrades with a decrease in their ability to exchange oxygen and carbon dioxide with the blood.

Alveolar tissue is destroyed, sharply reducing the useful surface area for gas exchange: once destroyed, 7 alveoli can no longer return to their previous state, they are irreparably damaged.

From a morphological point of view, there are several types of pulmonary emphysema:

• centrilobular (or centroacinar) pulmonary emphysema, the most common form in smokers;
• panlobular (or panacinous) emphysema;
• paraseptal emphysema;
• irregular emphysema.

What are the reasons

There can be many reasons, but in the West smoking (tobacco use) is the main reason (90% of cases).

Thus, causes include:

• cigarette smoking, including passive smoking
• inhalation of toxic substances;
• be a child of smoking mothers during pregnancy;
• air pollution;
• recurrent respiratory infections;
• prematurity and low birth weight;
• Alpha-1 antitrypsin deficiency.
• Cigarette smoke and respiratory inflammation

Inhalation of toxic fumes such as cigarette smoke damages cells and promotes inflammation.

This leads to the elimination of damaged cells and the simultaneous inhibition of natural repair mechanisms, which leads to the development of emphysema.

Lungs lose elasticity, alveoli rupture, creating large air spaces that reduce the surface area needed by the body to exchange oxygen and carbon dioxide.

This process, associated with chronic inhalation of harmful substances such as cigarette smoke, often co-occurs with a condition of chronic airway inflammation called chronic bronchitis leading to the complex pathology known as chronic obstructive bronchopathy.

Let’s not forget that persistent infections of the lower respiratory tract also cause inflammation and, by increasing the secretion of mucus, can contribute to the course of the disease.

Emphysema symptoms

One of the earliest symptoms of emphysema is definitely shortness of breath (or shortness of breath), which gradually worsens, first with strenuous exercise, then with daily tasks such as climbing stairs , and finally even at rest.

In addition, the progressive destruction of the alveoli and pulmonary capillaries, as well as the lack of oxygen, can lead to an increase in pressure in the pulmonary artery, which can lead to right ventricular failure (this is called “pulmonary heart failure”). .

Finally, patients with emphysema are more likely to develop pneumothorax, which is a tear in the lung tissue that causes the lung to collapse.

In addition to shortness of breath and heart failure, they may experience:

• dry cough with chronic sputum;
• fatigue;
• heart problems;
• fever;
• cyanosis of lips and nails.

How the diagnosis is made: tests to be done

Emphysema usually affects smokers around the age of 50 and is insidiously manifested by shortness of breath on exertion, which the patient often attributes to age or a sedentary lifestyle.

Unfortunately, patients often go to the doctor only after an attack of bronchitis, after which they can no longer breathe as before, and by this time the disease is already in an advanced stage.

For this reason, it is very important for general practitioners to be proactive in looking for disease in their smokers over 40 years of age by finding out if they have frequent coughs or shortness of breath during physical activity.

Persistent cough and shortness of breath: the first signs to look out for

It is therefore very important that a patient who smokes consult his doctor if he has

• cough almost every day for at least 3 months a year for 2 consecutive years
• shortness of breath during physical exertion, which did not bother him a year ago.

The family doctor will be able to take a correct history and conduct an objective examination, and then arrange appropriate examinations, possibly with the help of a pulmonologist, in order to determine the best therapy and prevention of complications.

spirometry

The most important test for diagnosing chronic obstructive pulmonary disease is spirometry, which will show the pattern of expiratory flow obstruction.

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This is a simple, non-invasive, inexpensive test that is easy to perform and interpret.

The test subject simply blows hard into the device, which measures airflow, starting with a deep breath.

Normally, a healthy person should be able to empty 70 to 80% of all the air they can exhale in the first second of the maneuver.

Patients with airway obstruction or loss of lung compliance, as occurs with emphysema, take much longer.

This obstruction usually has little or no response to a bronchodilator.

Further Functional Tests

Once the pattern has been identified, emphysema can be confirmed by performing other functional tests such as global spirometry and alveolar-capillary diffusion, which evaluate both lung hyperinflation and the loss of gas exchange efficiency typical of emphysema.

Computed tomography of the lung can also show areas of alveolar destruction at a very early stage.

In more severe cases, pulse oximetry measurement will provide information on blood oxygenation and, if necessary, arterial hemogas analysis, blood sampling from the wrist), it will be useful to check the correct gas exchange in the alveoli, the level of oxygen in the blood and predict the correct function of the lungs.

How to treat emphysema

There is no special treatment that can restore lost breathing function, the only thing that can change the natural course of emphysema is to stop smoking.

Smoking cessation reverses the accelerated decline in lung function, slowing down the progressive course of the disease.

Unfortunately, quitting smoking is not easy, but today we have smoke-free centers that can not only help in the fight against nicotine addiction, but also provide psychological support to counter psychological addiction.

This combined approach significantly improved smoking cessation success in motivated individuals.

In addition to quitting smoking, patients should be encouraged to lead a healthy lifestyle, maintain regular physical activity, and protect against influenza and pneumococcal vaccination.

Medical therapy for emphysema

Other treatments available are bronchodilators, which are used to reduce expiratory flow limitation by reducing lung hyperinflation and eliminating shortness of breath.

Anti-inflammatory drugs are also used, which in some patients can reduce bronchial obstruction and prevent bronchial exacerbation and thus preserve lung function.

These medicines can relieve symptoms and thus improve patients’ quality of life.

Antibiotics, on the other hand, are indicated only during exacerbations of chronic bronchitis or pneumococcal pneumonia.

Other treatments

Patients with severe respiratory failure should be given supplemental oxygen for at least 18 hours a day to prevent “pulmonary heart failure” (right ventricular failure).

On the other hand, all patients in whom shortness of breath interferes with their daily activities are indicated for respiratory rehabilitation.

The latter consists of a multidisciplinary program aimed at improving exercise tolerance through physiotherapy interventions to strengthen limb and respiratory muscles, as well as providing educational and nutritional support to help patients cope with their chronic disability.

Possible complications

The most common complications are exacerbations, defined as episodes of worsening shortness of breath and coughing, sometimes severe enough to threaten the patient’s life.

These episodes can further worsen lung function, resulting in a higher severity.

Exacerbations are often caused by viral, sometimes bacterial infections or pneumonia.

Sometimes they can also be complicated by heart attacks or episodes of heart failure.

Therefore, greater efforts are needed to find patients with this disease at the earliest stage, immediately start secondary prevention of smoking cessation, initiate appropriate drug therapy and interventions aimed at changing the lifestyle of patients so that the development of the disease can be counteracted. from the very beginning.

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