Other known risk factors

Infections: Bacterial and viral infections are major causes of exacerbations, and may contribute to the pathogenesis and progression of COPD.1

Genetics: COPD occurs more frequently amongst relatives of COPD patients who smoke than unrelated smokers.2 The best-known genetic basis for increasing a person’s risk of COPD is severe deficiency in the alpha-1 antitrypsin gene.1

Asthma/bronchial hyperreactivity: Asthma may be a risk factor for the development of COPD, although the evidence is not conclusive.1 Bronchial hyperreactivity has been shown to be an independent predictor of COPD in population studies.1

Gender: Some studies have indicated that women are more susceptible to the effects of tobacco smoke than men.1,3,4 This is of concern given the increasing rate of smoking among women. Women with severe COPD exhibit smaller airway lumens and disproportionately thicker airway walls relative to men with the same disease severity, illustrating the different impact of the disease on each sex.5

Socioeconomic status: There is evidence that the risk of developing COPD is inversely related to socioeconomic status.1 However this pattern may reflect that poverty is generally associated with exposure to indoor and outdoor pollutants, crowding and poor nutrition.

Lung growth and development: Factors that affect lung growth during gestation can affect an individual’s later risk of developing COPD. For example, early childhood lung infections and lower birth weight are associated with a decrease in FEV1 in adulthood.1

Chronic bronchitis: In young adults who smoke, the presence of chronic bronchitis is associated with an increased likelihood of developing COPD.1


  1. Global Initiative for Chronic Obstructive Lung Disease (GOLD): Global Strategy for the Diagnosis, Management, and Prevention of COPD. 2013. www.goldcopd.org
  2. Silverman EK, Chapman HA, Drazen JM, et al. Genetic epidemiology of severe, early-onset COPD. Risk to relatives for airflow obstruction and chronic bronchitis. Am J Respir Crit Care Med 1998;157:1770-8.
  3. Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA 1994;272:1497-505. 
  4. Silverman EK, Weiss ST, Drazen JM, et al. Gender-related differences in severe, early-onset chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000;162:2152-8.
  5. Martinez FJ, Curtis JL, Sciurba F, et al. National Emphysema Treatment Trial Research Group. Sex differences in severe pulmonary emphysema. Am J Respir Crit Care Med 2007;176:243-52.

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