The burden of chronic obstructive pulmonary disease and its attributable risk factors in the Middle East and North Africa region, 1990–2019

Chronic obstructive pulmonary disease (COPD) is defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as “a common, preventable and treatable disease that is characterised by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases”. The chief constituents of COPD are emphysema which is a permanent destructive enlargement of airspaces, and chronic bronchitis which is an excretion of sputum for at least 3 months per year for 2 successive years. Ageing, occupational exposure to dust and fumes, indoor and outdoor air pollutants, genetic risk factors and especially tobacco smoking are some of the risk factors for developing COPD. In the primary stages of the disease, the physical symptoms include a chronic cough, excessive sputum excretion, wheezing and shortness of breath and as the disease develops, dyspnea becomes more common. Mental conditions, such as anxiety and depression, are also common comorbidities of COPD and these predict a diminished quality of life, decreased exercise capacity and higher rates of exacerbations, along with increased mortality.