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Editorials |

Causes of Chronic Airway Disease

Michael C. F. Pain, MD, FCCP
Author and Funding Information

Affiliations: Melbourne, Australia 
 ,  Director of Thoracic Medicine, The Royal Melbourne Hospital, and Professorial Associate in Medicine, The University of Melbourne.

Correspondence to: Michael C. Pain, MD, FCCP, Thoracic Medicine, Royal Melbourne Hospital, Grattan Street, Parkville Victoria 3050, Australia



Chest. 1999;115(1):4-6. doi:10.1378/chest.115.1.4
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Chronic airway disease is a major cost to the community and, as a matter of some urgency, the causes of this group of conditions need to be defined. Most physicians would be able to point to a multifactorial situation with airway inflammation, loss of pulmonary elastic supporting tissue, bronchial muscular dysfunction, and accumulation of secretions due to mucociliary impairment all having the potential to explain the pathogenesis. The further superimposition of variables such as the hypoxic polycythemic response, central sensitivity to carbon dioxide, and hypoxic pulmonary vasoconstriction add to the spectrum of clinical syndromes. As to the reason why an individual develops chronic airway disease, current thinking would suggest that this is the tobacco-smoking-induced illness par excellence. Yet, this is too simplistic. All physicians will have seen elderly patients with impeccable pulmonary function who have been heavy cigarette smokers for their entire adult lives and, perhaps more unusually, lifetime nonsmokers with chronic airflow disease. Early studies examining tobacco smoking and ventilatory capacity suggested that there was more to it than simply the amount of tobacco consumed, and the operation of some other risk factor was suggested.1 About 25% of male cigarette smokers proceed to develop significant airway abnormality2 and the role of nonspecific bronchial reactivity in defining this subgroup at special risk has been examined but remains inconclusive.3,,4 Variation between individuals in the efficiency of protective mechanisms such as the antielastase systems may also be a factor determining the likelihood for emphysema.


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