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(Chest. 2005;128:3055-3064.)
© 2005 American College of Chest Physicians

COPD*

A Dust-Induced Disease?

Carlos E. Girod, MD and Talmadge E. King, Jr., MD, FCCP

* From the Division of Pulmonary and Critical Care Medicine (Dr. Girod), University of Texas Southwestern Medical Center, Dallas, TX; and the Division of Pulmonary and Critical Care Medicine (Dr. King), Department of Medicine, San Francisco General Hospital, University of California at San Francisco, San Francisco, CA.

Correspondence to: Carlos E. Girod, MD, Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9034; e-mail: carlos.girod{at}utsouthwestern.edu

Abstract

Various reports have demonstrated the importance of small airway inflammation in the development of airflow limitation and progression of COPD. This hypothesis proposes that the pathogenesis of COPD mirrors a chronic inhalational dust-induced disease. The putative inorganic dust in cigarette smoke is aluminum silicate or kaolinite, a common component of clay soils. Kaolinite has been recovered in the alveolar macrophages of smokers and has been reported as a constituent of tobacco products. The origin of kaolinite in tobacco products remains unknown, and possible potential sources are proposed. On inhalation, kaolinite deposition in the distal lung may promote macrophage accumulation within the terminal airways leading to a respiratory bronchiolitis. In the susceptible smoker, important genetic, environmental, immunologic, and mechanical factors interact and modulate this small airway inflammation, ultimately leading to the pathologic lesion of emphysema. Further studies into the effects of kaolinite on macrophage function and the subsequent development of respiratory bronchiolitis could lead to prevention of COPD at its precursor lesion.

Key Words: bronchiolitis • COPD, etiology • emphysema, etiology • kaolin • alveolar macrophages • smoking






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