Chronic obstructive pulmonary disease: aetiology, pathology, physiology and outcome

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Chronic obstructive pulmonary disease: aetiology, pathology, physiology and outcome

Ralalage, Dheera DDD; Hurst, John R; (2023) Chronic obstructive pulmonary disease: aetiology, pathology, physiology and outcome. Medicine , 51 (10) pp. 737-741. 10.1016/j.mpmed.2023.07.008. Green open access

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Abstract

Chronic obstructive pulmonary disease (COPD) is diagnosed on the basis of airflow obstruction, although the definition also encompasses emphysema. It develops when someone with an (often undefined) genetic susceptibility encounters sufficient inhaled triggers. Genetic susceptibility is complex and determined by multiple alleles; α1-antitrypsin deficiency is the best example of genetic risk. Cigarette smoke is the most common trigger in high-income countries, but globally important contributors include the burning of biomass fuel in under-ventilated spaces, and systematic disadvantage across the life-course affecting lung growth and development. The natural history of lung function decline and maximal lung function attainment is fundamental to understanding COPD. In individuals susceptible to the effects of smoke, the pulmonary inflammatory response is qualitatively and quantitatively different from that in non-susceptible individuals. Once established, inflammation persists even after exposure has ceased. Airflow obstruction in COPD results from a combination of airway wall inflammatory response, luminal mucus accumulation, destruction of small airways and loss of alveolar–airway attachments from emphysema. The major symptoms are breathlessness, cough and sputum expectoration. Breathlessness is multifactorial, but primarily driven by hyperinflation. Although progressive airflow obstruction is the hallmark of COPD, other outcomes are also important, notably exacerbations and the development of co-morbidities.

Type:	Article
Title:	Chronic obstructive pulmonary disease: aetiology, pathology, physiology and outcome
Open access status:	An open access version is available from UCL Discovery
DOI:	10.1016/j.mpmed.2023.07.008
Publisher version:	https://doi.org/10.1016/j.mpmed.2023.07.008
Language:	English
Additional information:	This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords:	Chronic bronchitis; chronic obstructive pulmonary disease; emphysema; exacerbation; spirometry
UCL classification:	UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Respiratory Medicine
URI:	https://discovery.ucl.ac.uk/id/eprint/10180255