Abstract
Chronic obstructive pulmonary disease (COPD) is a severe respiratory disease with high morbidity and mortality, representing the third leading cause of death worldwide. Traditional risk factors for COPD include aging, genetic predisposition, cigarette smoking, exposure to environmental pollutes, occupational exposure, and individual or parental respiratory disease history. In addition, latest studies have revealed novel and emerging risk factors. In this review, differential gender difference as a factor for COPD development at different territories is discussed for the first time. First, women seem to have more COPD, while more women die of COPD or have more severe COPD, in Western societies. This seems different from the impression that COPD dominants in men, which is true in Eastern societies. It might be related to higher rate of cigarette smoking in women in developed countries (i.e., 12.0% of women in United States smoke vs. 2.2% in China). Nonetheless, women in Eastern societies are exposed to more biomass usage. Second, modest elevation in PM2.5 levels at >∼21.4–32.7 μg/m3, previously considered “cleaner air,” is associated with incidence of COPD, indicating that more stringent goals should be set for the reduction of PM2.5 levels to prevent COPD development. Last but not least, e-cigarette use, which has become an epidemic especially among adolescents as officially declared by the United States government, has severe adverse effects that may cause development of COPD early in life. Built upon an overview of the established risk factors for COPD primarily focusing on cigarette smoking and environmental pollutions, the present review further discusses novel concepts, mechanisms, and solutions evolved around the emerging risk factors for COPD discussed above, understanding of which would likely enable better intervention of this devastating disease.
Highlights
Chronic obstructive pulmonary disease (COPD) is a prevalent disease characterized by progressive airflow limitation, pulmonary structural abnormalities, and chronic respiratory symptoms including chronic cough, increased sputum production, dyspnea, and wheezing (Celli and Wedzicha, 2019)
Due to the fact that many diseases are caused by multiple risk factors, which may interact with each other, the total of population-attributable fraction (PAF) for individual risk factors may be more than 100% in some cases (World Health Organization [WHO], 2020)
An estimated 15– 45% of patients with COPD have never smoked, according to current literatures (Salvi and Barnes, 2009; Lamprecht et al, 2011; Thomsen et al, 2013; Tan et al, 2015; Rajendra et al, 2018; Syamlal et al, 2019). Genetic factors such as those can be identified through family history, and other risk factors, including environment pollutions and/or epigenetic regulations in response to environmental pollutions, may play important roles in the pathogenesis of COPD in the never-smokers
Summary
Chronic obstructive pulmonary disease (COPD) is a prevalent disease characterized by progressive airflow limitation, pulmonary structural abnormalities, and chronic respiratory symptoms including chronic cough, increased sputum production, dyspnea, and wheezing (Celli and Wedzicha, 2019). The global prevalence of COPD increased by 44.2% from 1990 to 2015 (GBD 2015 Chronic Respiratory Disease Collaborators, 2017). In the year of 2016, 251 million cases of COPD was identified by the Global Burden of Diseases Study (World Health Organization [WHO], 2019a). In China, the China Pulmonary Health study (CPH) reported an overall 8.6% prevalence rate of COPD in a large cohort of 50,991 randomly recruited subjects (between 2012 and 2015) (Wang C. et al, 2018). Despite these mounting data indicating high morbidity and mortality of COPD worldwide, the underlying molecular mechanisms and risk factor profiles of COPD have remained incompletely understood. With particular focus on the emerging risk factors, we will discuss concepts, mechanisms, and solutions evolved around these emerging risk factors for COPD, understanding of which would no doubt enable better management of this devastating disease
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