Risk Factors for Chronic Obstructive Pulmonary Disease

Tobacco use is the number one risk factor for COPD and heavy smokers are at greatest risk. Cigarette smokers are at greater risk than cigar and pipe smokers. All smokers are at greater risk than lifelong nonsmokers.

Having alpha–1–antitrypsin (AAT) deficiency, also called familial emphysema, is another risk factor. People with familial emphysema have a rare hereditary deficiency of alpha–1–protease inhibitor. When there is a deficiency of AAT, the activity of elastase—an enzyme that breaks down elastin—is not inhibited and elastin degradation occurs unchecked.

Approximately 1% to 3% of all cases of emphysema are due to AAT deficiency. Patients with a severe genetic deficiency of AAT usually have symptoms (e.g., productive cough, wheezing) by the time they reach early middle age. Studies have shown an increased risk for AAT in people of certain ethnicities (e.g., Spanish, Danish, Latvian, Norwegian, Swedish, Portuguese, French Canadian).

A blood test may be used to diagnose this deficiency in patients who have COPD. Management of the condition may include weekly infusions of alpha–1–proteinase inhibitor (A1–PI) augmentation therapy to increase levels of AAT in the blood and lungs. It is critical that people with this deficiency never smoke.

Asthma also increases the risk for developing COPD later in life.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 31 May 2000

Last Modified: 10 Sep 2015