目前为止，吸烟是COPD（COPD）的主要危险因素。约 40% 至 70% 的 COPD 病例由吸烟导致，因为吸烟会导致炎性反应、纤毛功能障碍和氧化损伤。[17]Raherison C, Girodet PO. Epidemiology of COPD. Eur Respir Rev. 2009 Dec;18(114):213-21. http://err.ersjournals.com/content/18/114/213.long http://www.ncbi.nlm.nih.gov/pubmed/20956146?tool=bestpractice.com 空气污染、室内生物质燃料燃烧，以及粉尘职业暴露、化学试剂和烟雾为其他病因。[18]Park J, Kim HJ, Lee CH, et al. Impact of long-term exposure to ambient air pollution on the incidence of chronic obstructive pulmonary disease: A systematic review and meta-analysis. Environ Res. 2021 Mar;194:110703. https://www.doi.org/10.1016/j.envres.2020.110703 http://www.ncbi.nlm.nih.gov/pubmed/33417909?tool=bestpractice.com [19]Zhu RX, Nie XH, Chen YH, et al. Relationship between particulate matter (PM2.5) and hospitalizations and mortality of chronic obstructive pulmonary disease patients: a meta-analysis. Am J Med Sci. 2020 Jun;359(6):354-64. http://www.ncbi.nlm.nih.gov/pubmed/32498942?tool=bestpractice.com [20]Peng C, Yan Y, Li Z, et al. Chronic obstructive pulmonary disease caused by inhalation of dust: A meta-analysis. Medicine (Baltimore). 2020 Aug 21;99(34):e21908. https://www.doi.org/10.1097/MD.0000000000021908 http://www.ncbi.nlm.nih.gov/pubmed/32846856?tool=bestpractice.com 吸入高剂量杀虫剂与 COPD 发病率增加具有相关性，吸入高浓度颗粒物亦然。[21]Faruque MO, Boezen HM, Kromhout H, et al. Airborne occupational exposures and the risk of developing respiratory symptoms and airway obstruction in the Lifelines Cohort Study. Thorax. 2021 Mar 2;76(8):790-7. https://www.doi.org/10.1136/thoraxjnl-2020-216721 http://www.ncbi.nlm.nih.gov/pubmed/33653936?tool=bestpractice.com [22]Lytras T, Kogevinas M, Kromhout H, et al. Occupational exposures and 20-year incidence of COPD: the European Community Respiratory Health Survey. Thorax. 2018 Nov;73(11):1008-15. https://www.doi.org/10.1136/thoraxjnl-2017-211158 http://www.ncbi.nlm.nih.gov/pubmed/29574416?tool=bestpractice.com [23]Shin S, Bai L, Burnett RT, et al. Air pollution as a risk factor for incident chronic obstructive pulmonary disease and asthma. A 15-year population-based cohort study. Am J Respir Crit Care Med. 2021 May 1;203(9):1138-48. http://www.ncbi.nlm.nih.gov/pubmed/33147059?tool=bestpractice.com [24]Liu S, Lim YH, Pedersen M, et al. Long-term air pollution and road traffic noise exposure and COPD: the Danish Nurse Cohort. Eur Respir J. 2021 Dec 2;58(6):2004594. http://www.ncbi.nlm.nih.gov/pubmed/33986028?tool=bestpractice.com 氧化应激、蛋白酶与抗蛋白酶之间的失衡，亦为 COPD 发病机制重要因素，尤其是 α-1 抗胰蛋白酶缺乏患者。[25]Eapen MS, Sohal SS. Update on the pathogenesis of COPD. N Engl J Med. 2019 Dec 19;381(25):2483-4. http://www.ncbi.nlm.nih.gov/pubmed/31851815?tool=bestpractice.com 对最佳肺生长和肺功能构成影响的过程，可使 COPD 罹患风险升高。[26]Lange P, Celli B, Agustí A, et al. Lung-function trajectories leading to chronic obstructive pulmonary disease. N Engl J Med. 2015 Jul 9;373(2):111-22. https://www.doi.org/10.1056/NEJMoa1411532 http://www.ncbi.nlm.nih.gov/pubmed/26154786?tool=bestpractice.com 此类过程可以追溯至妊娠、出生、童年和青春期。例如，出生体重与成年期 FEV1 呈正相关。对于成年期肺功能预测，童年不利因素可能与大量吸烟同等重要。[27]Lawlor DA, Ebrahim S, Davey Smith G. Association of birth weight with adult lung function: findings from the British Women's Heart and Health Study and a meta-analysis. Thorax. 2005 Oct;60(10):851-8. https://www.doi.org/10.1136/thx.2005.042408 http://www.ncbi.nlm.nih.gov/pubmed/16055617?tool=bestpractice.com