Pathogenesis of chronic obstructive pulmonary disease

Proc Am Thorac Soc. 2005;2(4):258-66; discussion 290-1. doi: 10.1513/pats.200504-045SR.


The current paradigm for the pathogenesis of chronic obstructive pulmonary disease is that chronic airflow limitation results from an abnormal inflammatory response to inhaled particles and gases in the lung. Airspace inflammation appears to be different in susceptible smokers and involves a predominance of CD8+ T lymphocytes, neutrophils, and macrophages. Studies have characterized inflammation in the peripheral airspaces in different stages of disease severity. Two other processes have received considerable research attention. The first is a protease-antiprotease imbalance, which has been linked to the pathogenesis of emphysema. However, the hypothesis of an increased protease burden associated with functional inhibition of antiproteases has been difficult to prove and is now considered an oversimplification. The second process, oxidative stress, has a role in many of the pathogenic processes of chronic obstructive pulmonary disease and may be one mechanism that enhances the inflammatory response. In addition, it has been proposed that the development of emphysema may involve alveolar cell loss through apoptosis. This mechanism may involve the vascular endothelial growth factor pathway and oxidative stress.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Animals
  • Bronchitis, Chronic / pathology
  • Bronchitis, Chronic / physiopathology
  • Humans
  • Inflammation
  • Lung / pathology
  • Lung / physiopathology
  • Oxidative Stress
  • Peptide Hydrolases / physiology
  • Protease Inhibitors / metabolism
  • Pulmonary Disease, Chronic Obstructive / pathology
  • Pulmonary Disease, Chronic Obstructive / physiopathology*
  • Pulmonary Emphysema / pathology
  • Pulmonary Emphysema / physiopathology
  • Smoking / adverse effects


  • Protease Inhibitors
  • Peptide Hydrolases