At+risk+Populations


 * At-risk Populations for COPD **

__Smoking__

The leading cause of COPD in developed countries is smoking (Buist, 2002; DeMeo & Weiss, 2002; American Association of Cardiovascular and Pulmonary Rehabilitation, 2004; Celli, 2000; Hodgkin, 2000). In fact, some figures state that smoking is the cause of 90% of all cases of COPD (Gerritsen, Feijen & Postma, 2002).

__Other pollutants__

COPD can also be caused by other air pollutants, both environmental and occupational (American Association of Cardiovascular and Pulmonary Rehabilitation, 2004); however this is more common in patients from developing countries (Buist, 2002).

__Gender__

Due to the association with smoking, it is not surprising that rates of COPD reflect the rates of smoking in the general population. Men have higher instances of COPD, while women are catching up steadily (Buist, 2002; DeMeo & Weiss, 2002; American Association of Cardiovascular and Pulmonary Rehabilitation, 2004)

__Age of onset__

COPD usually develops later in adult life, with the majority of cases developing in the sixth or seventh decade of life (Buist, 2002; Celli, 2000).

__Genetics__

The effect of genetics on one’s susceptibility to COPD is under some debate. Buist (2002) states that family history of COPD is not important. In contrast, Gerritsen, Feijen, & Postma (2002) state that although COPD is not inherited, susceptibility may be genetic. The American Association of Cardiovascular and Pulmonary Rehabilitation (2004) also recommends that family history of lung disease should be considered a possible indicator of susceptibility to COPD.

__Income__

Rates of COPD are higher in populations of low income (DeMeo & Weiss, 2002).

__Asthma, allergies and bronchial hyper-responsiveness__

Childhood asthma, allergies, and bronchial hyper-responsiveness have all been linked to increased susceptibility of developing COPD in later life (DeMeo & Weiss, 2002; Martinez, 2002). However more research is needed in this area to determine the significance of this relationship.

**COPD Exacerbation**

The severity of COPD related dysphasia will increase during times of COPD exacerbation. The primary causes of COPD exacerbation are (Miller, 2000, p.16):


 * Viral infection.
 * Failure of bronchial hygiene with bacterial infection.
 * Allergic inflammation.
 * Reactions to changes in humidity of temperature.
 * Severe emotional or physical stress.

**References**

Curtis, J., & Langmore, S. (1997). Respiratory function and complications related to deglutition. In A. Perlman, & K. Schulze-Derieu (Eds.), Deglutition and its disorders: Anatomy, physiology, clinical diagnosis, and management (pp. 99-122). San Diego, CA: Singular Publishing Group.

Gross, R., Atwood, C., Ross, S., Olszewski, J., & Eichhorn, K. (2009). The coordination of breathing and swallowing in chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 179(7), 559-565.

Kijima, M., Isono, S., & Nishino, T. (1999). Coordination of swallowing and phases of respiration during added respiratory loads in awake subjects. American Journal of Respiratory and Critical Care Medicine, 159(6), 1898-1902.

Mckinstry, A., Tranter, M., & Sweeney, J. (2010). Outcomes of dysphagia intervention in a pulmonary rehabilitation program. Dysphagia, 25(2), 104-111.

Mokhlesi, B., Logemann, J., Rademaker, A., Stangl, C., & Corbridge, C. (2002). Oropharyngeal deglutition in stable COPD. CHEST, 121(2), 361-369.

Shaker, R., Li, Q., Ren, J., Townsend, W., Dodds, W., Martin, B., Kern, M., & Rynders, A. (1992). Coordination of deglutition and phases of respiration: Effect of aging, tachypnea, bolus volume, and chronic obstructive pulmonary disease. American Journal of Physiology, 263(5), 750-755.