This is another brilliant insight you are bringing to the story, because emphysema as well, is the fundamental problem underlying both frank emphysema and COPD. The differences are largely the nature of the immune response and whether there are any other immune triggers exacerbating the circumstances, for example, with an overlay of asthma. With the latter complication, there will be environmental insults, potentially of multiple origins, from pollen, mold spores, etc., that are risk factors and add to the worsening over time so typical of these conditions. In the absence of allergies, what will be seen is strictly emphysema, and that is a characteristic of having such an ongoing infection within the lung. And the nature of the particular immune attack in that location is a result of unique aspects to immunity serving to protect the airway as an interface with the environment, as topologically, the interior of the lung is outside the body and many things gain access to the airways, even the deepest branches. As with the intestine, there is an ongoing back-and-forth warfare taking place because there are many airborne pathogens prevalent in the environment. So depending on the immune status of an individual person, a chronic viral infection causing a steady decline in pulmonary function will be aggravated by the normal periodic pockets of bacterial invasion that come and go, normally without incident, being subclinical because there is usually full healing eventually. But in an individual with a chronic viral infection in the lung, the relentless immune response takes a toll over time because the tissue can never repair fully. And then, any overlay of bacterial invasion will cause a worsening to extend the damage quickly. It is the cumulative effect of this contest that causes a steady decline and shortening of the life.
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