COPD – a way of life

Left unchecked, tobacco will kill one billion people in the 21st century

The tobacco epidemic is a global transversal problem. From bans on cigarette advertising and smoking in public spaces to challenging the influence of the strong multinational tobacco industry, action needs to be taken on a global scale to end the worldwide damage, disease and death caused by tobacco.

Dr. George L. Waldbott, an American allergologist, first described a new disease, which he named “smoker’s respiratory syndrome”, in the 1953 Journal of the American Medical Association. This was the first association between tobacco smoking and chronic respiratory disease and this fact has not been denied since.

Early treatments included garlic, cinnamon and ipecac syrup, among others. Modern treatments were only developed during the second half of the 20th century.

Chronic obstructive pulmonary disease (COPD) is a significant, hard to handle, breathing disease impacting society today and one of the world’s most common non-communicable health problems. Breathing becomes more and more difficult due to the progressive obstruction of the airways.

What causes COPD?

Cigarette smoke
COPD can be caused by many factors, although the most common cause is, without question, cigarette smoke.
The likelihood of developing COPD increases the more the person smokes and the longer you’ve been smoking. This is because smoking irritates and inflames the lungs, which results in scarring.

Environmental factors
Inhaling irritating particles, such as smoke or air pollutants are also relevant causes.
Air pollution and polluted work conditions may cause some cases of COPD, or make the disease worse. COPD can develop if small amounts of these irritants are inhaled over a long period of time or if large amounts are inhaled over a short period of time. The combination effect of occupational exposure to air pollutants and smoking increases the chances of developing COPD.

A small number of people have a hereditary (genetic) risk of COPD due to very rare protein deficiencies. Less than one in 100 cases of COPD are due to this.
The reason why some smokers never develop COPD is not yet fully understood. Family genes probably play a major role in who develops COPD.


■ Up to 25% of smokers develop COPD. Of those who are lifelong smokers, about half will get COPD. Of those with COPD, 80-95% are either current smokers or previously smoked.

■ About three in 20 people who smoke one packet of cigarettes (20 cigarettes) per day and one in four of 40-per-day smokers develop COPD if they continue to smoke.

■ Smoking is thought to be responsible for around 90% of cases, although as many as one out of six people with COPD never smoked.

■ Smoking is the cause of the majority of cases, but air pollution and polluted work conditions may cause new cases or make the disease worse. The likelihood of developing COPD increases the more you smoke and the longer you have been smoking.

■ However, people who have never smoked rarely develop COPD.

■ Passive smoking remains, however, a potential cause. Second-hand smoking causes many of the same diseases as direct smoking, including cardiovascular diseases, lung cancer and respiratory diseases.

■ Making changes to your lifestyle can usually prevent severe COPD.


Prevalence is increasing both in developing and developed countries as a result of worldwide tobacco consumption as well as environmental exposures such as biomass fuel smoke. The growing elderly population due to fewer deaths from other causes such as infectious diseases is also a relevant factor.

As of 2013, COPD affects 329 million people or nearly 5% of the global population, although the true prevalence may well be higher due to under-diagnosis. It typically occurs in people over the age of 40. Males and females are affected equally.

In 2013 it resulted in 2.9 million deaths, up from 2.4 million deaths in 1990. More than 90% of these deaths occur in the developing world.

By 2020, COPD is predicted to become the third leading cause of death worldwide.

Smoking accounts for as many as nine out of 10 COPD related deaths.


Globally, COPD results in extensive economic costs, direct costs such as medical care and indirect costs such as missed work and loss of productivity. This is expected to more than double by the year 2030. 

In Europe, COPD represents 3% of healthcare spending. COPD is among the most expensive conditions seen in hospitals.

COPD has significant personal, economic and social burden on working age people.

Although COPD is considered to be a disease of later years, estimates suggest that 50% of those with COPD are less than 65 years old.


If you smoke, stopping is the single most effective way to reduce your risk of getting the condition.

Severe COPD can usually be prevented by making changes to your lifestyle.

Most cases of COPD are potentially preventable through decreasing exposure to smoke and improving air quality.

Annual influenza vaccinations in those with COPD reduce exacerbations, hospitalisations and death. Pneumococcal vaccination may also be beneficial.

Smoking cessation

Keeping people from starting smoking is a key aspect of preventing COPD. The policies of governments, public health agencies, and anti-smoking organisations can reduce smoking rates by discouraging people from starting and encouraging people to stop smoking. Smoking bans in public areas and places of work are certainly important measures to decrease exposure to second-hand smoke, but there is a lot more to be done.

For those who smoke, stopping smoking is the only measure shown to slow down the worsening of COPD. Even at a late stage of the disease it can reduce the rate of worsening lung function and delay the onset of disability and death.

Smoking cessation starts with the decision to stop smoking, leading to an attempt at quitting. Often several attempts are required before long-term abstinence is achieved. Attempts over five years lead to success in nearly 40% of people.

Some smokers can achieve long-term smoking cessation through willpower alone; many smokers need further support. The chance of quitting is improved with social support, engagement in a smoking cessation programme and the use of medication.

A lot of frightening facts and figures … but seeing reality face to face can be a lot more frightening.

Although through times smoking has been a fashionable, adequate behavior, smoking is dangerous and highly addictive, thus not easy to deal with or to quit.

The worse fact is that smoking is a socially accepted drug and that is what needs to be changed!

Best health wishes,
Dr. Maria Alice

By Dr Maria Alice
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Dr Maria Alice is a consultant in General and Family Medicine. General Manager/Medical Director – Luzdoc International Medical Service / Medilagos. Medical Director – Grupo Hospital Particular do Algarve