Hopp til innhold
NHI.no
Annonse
Informasjon

Årsaker til kols

Hos to tredjedeler av alle som har fått kols-diagnosen i Norge, er røyking den viktigste årsaken.

askebeger
Illustrasjonsfoto

Sist oppdatert:

1. mars 2022

Innhold i artikkelen

Røyking

I Norge er røyking årsaken til kols hos rundt to av tre pasienter. Sigarettrøyking er mest vanlig, men også pipetobakk, sigar eller andre former for tobakksrøyking kan føre til kols. Tobakksrøyk inneholder kjemiske stoffer og skadelige partikler som irriterer luftveiene og ødelegger celler i lungene. Eksponering for tobakksrøyk øker risikoen for blant annet kronisk obstruktiv lungesykdom (kols) og lungekreft. Den medfører også en rekke andre skadelige effekter på kroppen. I lungene skaper de skadelige stoffene i sigarettrøyken en kronisk irritasjon (betennelse) i slimhinnene.

Annonse

Etter hvert vil denne betennelsen føre til sårdannelser og ødeleggelse av de normale strukturene. Normale celler blir erstattet av bindevev (arrvev). Dette og den vedvarende betennelsesreaksjonen i lungevevet fører til hindret luftstrøm (obstruksjon) og nedsatt lungekapasitet.

Følgen er hindret overføring av oksygen fra innåndingsluften til de tynne blodårene i lungene. Dette forårsaker nedsatt oksygeninnhold i blodet og tiltagende åndenød ved anstrengelse. Ved langtkommen sykdom oppstår tung pust også i hvile.

Vil du vite mer

Dette dokumentet er basert på det profesjonelle dokumentet Kols . Referanselisten for dette dokumentet vises nedenfor

  1. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2025 report). Global Initiative for Chronic Obstructive Lung Disease (GOLD). Available from: goldcopd.org
  2. Hetlevik Ø, Melbye H, Gjesdal S. GP Utilisation by Education Level Among Adults With COPD or Asthma: A Cross-Sectional Register-Based Study. NPJ Prim Care Respir Med 2016; 26: 16027. pmid:27279354 PubMed
  3. Agustí A, Celli BR, Criner GJ, et al.. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Eur Respir J. 2023 Apr 1;61(4):2300239. doi: 10.1183/13993003.00239-2023. PMID: 36858443 PubMed
  4. Melbye H, Drivenes E, Dalbak LG, et al.. Asthma, chronic obstructive pulmonary disease, or both? Diagnostic labeling and spirometry in primary care patients aged 40 years or more. Int J Chron Obstruct Pulmon Dis. 2011;6:597-603. Epub 2011 Nov 17. PMID: 22135492 PubMed
  5. Folkehelseinstituttet. Tall fra Dødsårsaksregisteret for 2020. www.fhi.no
  6. Bhatta L, Leivseth L, Mai XM, et al.. Prevalence and trend of COPD from 1995-1997 to 2006-2008: The HUNT study, Norway. Respir Med. 2018 May;138:50-56. doi: 10.1016/j.rmed.2018.03.020. Epub 2018 Mar 21. PMID: 29724393 PubMed
  7. Melbye H, Helgeland J, Karlstad Ø, et al. Is the Disease Burden From COPD in Norway Falling Off? A Study of Time Trends in Three Different Data Sources. Int J Chron Obstruct Pulmon Dis 2020; 15: 323-334. pmid:32103931 PubMed
  8. Gibson GJ, Loddenkemper R, Sibille Y, et al. European lung white book, chapter 13 (COPD). European Respiratory Society. ERS Publications Office, 2016.
  9. WHO, newsroom, fact sheets: The top 10 causes of death. Publisert 9.12.2020. www.who.int
  10. Chapman KR, Mannino DM, Soriano JB et al. Epidemiology and costs of chronic obstructive pulmonary disease. Eur Respir J 2006; 27: 188-207. PubMed
  11. Johannessen A, Omenaas ER, Bakke PS, Gulsvik A. Implications of reversibility testing on prevalence and risk factors for chronic obstructive pulmonary disease: a community study. Thorax 2005; 60: 842-7. PubMed
  12. Lamprecht B, McBurnie M, Vollmer W, et al. COPD in Never Smokers. Chest 2011; 139: 752–763. doi:10.1378/chest.10-1253. Pmid: 20884729 PubMed
  13. Danielsen SE, Løchen ML, Medbø A, et al. A new diagnosis of asthma or COPD is linked to smoking cessation – the Tromsø study. Int J Chron Obstruct Pulmon Dis 2016; 11: 1453-8. pmid:27418818 PubMed
  14. 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. doi: 10.1056/NEJMoa1411532. PMID: 26154786 PubMed
  15. Dockery DW, Brunekreef B. Longitudinal studies of air pollution effects on lung function. Am J Respir Crit Care Med 1996; 154 (6 pt 2) (suppl): S250-6.
  16. Li MH, Fan LC, Mao B, et al.. Short-term Exposure to Ambient Fine Particulate Matter Increases Hospitalizations and Mortality in COPD: A Systematic Review and Meta-analysis. Chest 2016 Feb; 149(2): 447-458. pmid:26111257 PubMed
  17. Liu S, Zhou Y, Liu S, et al.. Association between exposure to ambient particulate matter and chronic obstructive pulmonary disease: results from a cross-sectional study in China. Thorax 2017 Sep; 72(9): 788-795. pmid:27941160 PubMed
  18. Stern AD, Morgan WJ, Wright AL, Guerra S and Martinez FD. Poor airway function in early infancy and lung function by age 22 years: a non-selective longitudinal cohort study. Lancet 2007; 370: 758-64. PubMed
  19. American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease: ATS statement. Am J Respir Crit Care Med 1995; 152 (5 pt 2) (suppl): S77-120.
  20. The Alpha-1-Antitrypsin Deficiency Registry Study Group. Survival and FEV1 decline in individuals with severe deficiency of alpha1-antitrypsin. Am J Respir Crit Care Med 1998; 158: 49-59. PubMed
  21. McCloskey SC, Patel BD, Hinchliffe SJ, et al . Siblings of patients with severe chronic obstructive pulmonary disease have a significant risk of airflow obstruction. Am J Respir Crit Care Med 2001 Oct; 164(8 Pt 1): 1419-24. pmid:11704589 PubMed
  22. Ringbæk T, Lange P, Mogensen T, Fezi S. Iltbehandling ved akut eksacerbation af kronisk obstruktiv lungesygdom. Ugeskr Læger 2008; 170: 1634-8. PubMed
  23. Singh D, Agusti A, Martinez FJ, et al. Blood Eosinophils and Chronic Obstructive Pulmonary Disease: A Global Initiative for Chronic Obstructive Lung Disease Science Committee 2022 Review. Am J Respir Crit Care Med. 2022;206(1):17-24. PubMed
  24. Pascoe S, Locantore N, Dransfield MT, Barnes NC, Pavord ID. Blood eosinophil counts, exacerbations, and response to the addition of inhaled fluticasone furoate to vilanterol in patients with chronic obstructive pulmonary disease: a secondary analysis of data from two parallel randomised controlled trials. Lancet Respir Med 2015;3:435-442. PubMed
  25. Bhatt SP, Rabe KF, Hanania NA, et al. Dupilumab for COPD with Type 2 Inflammation Indicated by Eosinophil Counts. N Engl J Med. 2023;389(3):205-214. PubMed
  26. Wilkinson TMA, Aris E, Bourne S, et al. A prospective, observational cohort study of the seasonal dynamics of airway pathogens in the aetiology of exacerbations in COPD. Thorax 2017; 72(10): 919-927. pmid:28432209 PubMed
  27. Schneider D, Ganesan S, Comstock AT, et al. Increased cytokine response of rhinovirus-infected airway epithelial cells in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2010; 182(3): 332-40. pmid:20395558 PubMed
  28. Garcha DS, Thurston SJ, Patel AR, et al. Changes in prevalence and load of airway bacteria using quantitative PCR in stable and exacerbated COPD. Thorax 2012;67:1075–80. PMID: 22863758 PubMed
  29. Huang YJ, Sethi S, Murphy T, et al. Airway microbiome dynamics in exacerbations of chronic obstructive pulmonary disease. J Clin Microbiol 2014;52:2813–23. PMID: 24850358 PubMed
  30. Rahman AA, Dell'Aniello S, Moodie EEM, et al. Gabapentinoids and Risk for Severe Exacerbation in Chronic Obstructive Pulmonary Disease : A Population-Based Cohort Study. Ann Intern Med 2024. pmid:38224592 PubMed
  31. van Oostrom SH, Engelfriet PM, Verschuren WMM. Aging-related trajectories of lung function in the general population-The Doetinchem Cohort Study. PLoS One 2018 ; 13(5): e0197250. pmid:29768509 PubMed
  32. Scanlon PD, Connett JE, Waller LA, Altose MD, Bailey WC, Buist AS. Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease. The Lung Health Study. Am J Respir Crit Care Med 2000; 161: 381-90. PubMed
  33. Doherty DE. Early detection and management of COPD. What you can do to reduce the impact of this disabling disease. Postgrad Med 2002;111: 41-4,49-50,53.
  34. Ulvestad B, Lund MB. Tunnelarbeid gir økt risiko for kronisk obstruktiv lungesykdom. Tidsskr Nor Lægeforen 2003; 123: 2292-5. PubMed
  35. Paulin LM, Diette GB, Blanc PD, et al.. SPIROMICS Research Group. Occupational exposures are associated with worse morbidity in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2015 Mar 1;191(5):557-65. PMID: 25562375 PubMed
  36. Bigna JJ, Kenne AM, Asangbeh SL, Sibetcheu AT. Prevalence of chronic obstructive pulmonary disease in the global population with HIV: a systematic review and meta-analysis. Lancet Glob Health 2018; 6(2): e193-e202. pmid:29254748 PubMed
  37. Hvidsten SC, Storesund L, Wentzel-Larsen T, et al. Prevalence and predictors of undiagnosed chronic obstructive pulmonary disease in a Norwegian adult general population. Clin Respir J 2010 Jan; 4(1): 13-21. pmid:20298413 PubMed
  38. Helsedirektoratet. Kols – diagnostisering og behandling. Nasjonal faglig retningslinje. Sist faglig oppdatert 15. februar 2022. Siden lest 08.08.2025. www.helsedirektoratet.no
  39. Kols. Nasjonal faglig retningslinje og veileder for forebygging, diagnostisering og oppfølging. IS-2029N. Helsedirektoratet, 2012. helsedirektoratet.no
  40. Lange P, Marott JL, Vestbo J, et al. Prediction of the clinical course of chronic obstructive pulmonary disease, using the new GOLD classification: a study of the general population. Am J Respir Crit Care Med 2012; 186(10): 975-81. pmid:22997207 PubMed
  41. Hirano T, Matsunaga K. Late-onset asthma: current perspectives. J Asthma Allergy. 2018 Feb 9;11:19-27. doi: 10.2147/JAA.S125948. PMID: 29445292 PubMed
  42. Langhammer A, Weisser K, Melbye H, et al. Kolsveileder for allmennpraksis. Publisert 2022, oppdatert november 2024. www.lungeripraksis.no
  43. Eltayara L, Ghezzo H, Milic-Emili J. Orthopnea and tidal expiratory flow limitation in patients with stable COPD. Chest 2001 Jan; 119(1): 99-104. pmid:11157590 PubMed
  44. Dewar M, Curry RW Jr.. Chronic obstructive pulmonary disease: diagnostic considerations. Am Fam Physician 2006; 73(4): 669-76. pmid:16506711 PubMed
  45. Melbye H, Al-Ani S, Spigt M. Drop in lung function during asthma and COPD exacerbations - can it be assessed without spirometry?. Int J Chron Obstruct Pulmon Dis 2016; 11: 3145-3152. pmid:27994453 PubMed
  46. Langhammer A, Jakobsen A, Sjaastad G, Østrem A. Astmaveileder for allmennpraksis. 2022. www.lungeripraksis.no
  47. Nationella riktlinjer för vård vid astma och KOL. Publicerad: www.socialstyrelsen.se, december 2020. www.socialstyrelsen.se
  48. Muller NL, Coxson H. Chronic obstructive pulmonary disease. 4: imaging the lungs in patients with chronic obstructive pulmonary disease. Thorax 2002; 57: 982-5. PubMed
  49. Helsedirektoratet. Antibiotikabruk i primærhelsetjenesten. Nasjonal faglig retningslinje. Infeksjoner i nedre luftveier. Kols-forverring. Sist faglig oppdatert 07.09.2022. Siden besøkt 26.09.2023. www.helsedirektoratet.no
  50. Hunskår S. Allmennmedisin, 4. utgave. Kapittel 3.9, Lunger og luftveier. Melbye H, Langhammer A: kols. Publisert av Gyldendal Norsk Forlag AS, 2023.
  51. Barnes PJ, Burney PG, Silverman EK, et al.. Chronic obstructive pulmonary disease. Nat Rev Dis Primers. 2015 Dec 3;1:15076. PMID: 27189863.
  52. Willemse BWM, Postma DS, Timens W, ten Hacken NHT. The impact of smoking cessation on respiratory symptoms, lungfunction, airway hyperresponsiveness and inflammation. Eur Respir J 2004; 23: 464–476. DOI: 10.1183/09031936.04.00012704 DOI
  53. Ferreira IM, Brooks D, White J, et al. Nutritional supplementation for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2012 Dec 12; 12: CD000998. pmid:23235577 PubMed
  54. Austin MA, Wills KE, Blizzard L, et al. Effect og high flow oxygen on mortality in chronic obstgructive pulmonary disease patients in prehospital setting: randomised controlled trial. BMJ 2010; 341: c5462. BMJ (DOI)
  55. Nasjonal faglig retningslinje for langtids mekanisk ventilasjon (LTMV). Helsedirektoratet, IS-2004. Utgitt 06/2012. helsedirektoratet.no
  56. Walters JA, Tan DJ, White CJ, et al. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. obstructive pulmonary disease. Cochrane Database Syst Rev. 2014 Sep 1;9:CD001288. Cochrane (DOI)
  57. Vollenweider DJ, Jarrett H, Steurer-Stey CA, et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2012; 2: CD010257. doi: 10.1002/14651858.CD010257 DOI
  58. Ram FSF, Picot J, Lightowler J, Wedzicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD004104. DOI: 10.1002/14651858.CD004104.pub3 DOI
  59. Beltaief K, Msolli MA, Zorgati A, et al. Nebulized terbutaline & ipratropium bromide vs terbutaline alone in acute exacerbation of COPD requiring noninvasive ventilation: a randomized double blind controlled trial. Acad Emerg Med. 2018 Aug 29. doi: 10.1111/acem.13560. PMID: 30156361 PubMed
  60. Butler CC, Gillespie D, White P, et al. C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations. N Engl J Med 2019; 381: 111-20. pmid:31291514 PubMed
  61. Miravitlles M, Moragas A, Hernández S, et al. Is it possible to identify exacerbations of mild to moderate COPD that do not require antibiotic treatment?. Chest 2013; 144(5): 1571-1577. pmid:23807094 PubMed
  62. Kew KM, Mavergames C, Walters JA. Long-acting beta-agonists for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2013 Oct 15;10:CD010177. Cochrane (DOI)
  63. Cheyne L, Irvin-Sellers MJ, White J. Tiotropium versus ipratropium bromide for chronic obstructive pulmonary disease. Cochrane Database of Syst Rev 2015, Issue 9. Art. No.: CD009552. DOI: 10.1002/14651858.CD009552.pub3. DOI
  64. Ismaila AS, Huisman EL, Punekar YS, et al.. Comparative efficacy of long-acting muscarinic antagonist monotherapies in COPD: a systematic review and network meta-analysis. Int J Chron Obstruct Pulmon Dis 2015 Nov; 16;10: 2495-517. pmid:26604738 PubMed
  65. Horita N, Goto A, Shibata Y, et al.. Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA) versus LABA plus inhaled corticosteroid (ICS) for stable chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2017 Feb 10. pmid:28185242 PubMed
  66. Gershon A, Croxford R, Calzavara A, et al. Cardiovascular safety of inhaled long-acting bronchodilators in individuals with chronic obstructive pulmonary disease. JAMA Intern Med 2013 May 20:1-9. doi:10.1001/jamainternmed.2013.1016. Pmid 23689820
  67. Calverley PMA, Rabe KF, Goehring U-M, et al. Roflumilast in symptomatic chronic obstructive pulmonary disease: two randomised clinical trials. Lancet 2009; 374: 685-94. PubMed
  68. Martinez, FJ, Calverley PMA, Goehring U-M, et al. Effect of roflumilast on exacerbations in patients with severe chronic obstructive pulmonary disease uncontrolled by combination therapy (REACT): a multicentre randomised controlled trial. Lancet. 2015 Mar 7;385(9971):857-66. PMID: 25684586 PubMed
  69. Chong J, Leung B, Poole P. Phosphodiesterase 4 inhibitors for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2013 Nov 4;11:CD002309. doi: 10.1002/14651858.CD002309.pub4. DOI
  70. Gauld DR, Pain MC, Rubinfeld AR, et al. Beta-blocking drugs and airways obstruction. Med J Aust 1978 Jul 28; 2(2): 88. pmid:40102 PubMed
  71. Williams IP, Millard FJ. Severe asthma after inadvertent ingestion of oxprenolol. Thorax 1980;35:160.
  72. Short PM, Lipworth SIW, Elder DHJ, et al. Effect of β blockers in treatment of chronic obstructive pulmonary disease: a retrospective cohort study . BMJ 2011; 342: d2549. BMJ (DOI)
  73. Rutten FH, Zuithoff NP, Hak E, Grobbee DE, Hoes AW. Beta-blockers may reduce mortality and risk of exacerbations in patients with chronic obstructive pulmonary disease. Arch Intern Med 2010; 170: 880-7. PubMed
  74. Ryan NM, Birring SS, Gibson PG. Gabapentin for refractory chronic cough: a randomised, double-blind, placebo-controlled trial. Lancet 2012 Aug 27. pmid:22951084. PubMed
  75. Farver-Vestergaard I, Jacobsen D, Zachariae R, et al. Efficacy of psychosocial interventions on psychological and physical health outcomes in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Psychoter Psychosom 2015; 84(1): 37-50. pmid:25547641 PubMed
  76. Cramer H, Haller H, Klose P, et al. The risks and benefits of yoga for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Clin Rehabil. 2019 Jul 29:269215519860551. PMID: 31353959 PubMed
  77. McCarthy B, Casey D, Devane D, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015 Feb 23;2:CD003793. PMID: 25705944 PubMed
  78. Lynn J. Perspectives on care at the close of life. Serving patients who may die soon and their families: the role of hospice and other services. JAMA 2001 Feb 21;285(7):925-932 PubMed
  79. Simon ST, Higginson IJ, Booth S, et al. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database Syst.Rev. 2010; 20:CD007354. Cochrane (DOI)
  80. Folkehelseinstituttet: Vaksinasjonsveilederen. www.fhi.no
  81. Herath SC, Normansell R, Maisey S, et al. Prophylactic antibiotic therapy for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev. 2018 Oct 30;10:CD009764. doi: 10.1002/14651858.CD009764.pub3. (Review) Pmid: 30376188 PubMed
  82. Han MK, Tayob N, Murray S, et al.. Predictors of chronic obstructive pulmonary disease exacerbation reduction in response to daily azithromycin therapy. Am J Respir Crit Care Med 2014 Jun; 15;189(12): 1503-8. pmid:24779680 PubMed
  83. Jolliffe DA, Greenberg L, Hooper RL, et al. Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials. Thorax. 2019 Jan 10. pii: thoraxjnl-2018-212092. doi: 10.1136/thoraxjnl-2018-212092. Pmid: 30630893 PubMed
  84. Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilatior on the rate of decline of FEV 1 : the lung health study. JAMA 1994; 272: 1497-1505. Journal of the American Medical Association
  85. Vestbo J, Edwards LD, Scanlon PD, et al. Changes in forced expiratory volume in 1 second over time in COPD. N Engl J Med 2011; 365: 1184-92. New England Journal of Medicine
  86. Dewar M, Curry RW. Chronic obstructive pulmonary disease: diagnostic considerations. Am Fam Physician 2006; 73: 669-76. PubMed
  87. Tkác J, Man SF, Sin DD. Systemic consequences of COPD. Ther Adv Respir Dis. 2007 Oct;1(1):47-59. PMID: 19124347 PubMed
  88. Wang M, Liou J, Lin CW, Tsai C, Wang Y, Hsu Y, Lai J. Association of Cardiovascular Risk With Inhaled Long-Acting Bronchodilators in Patients With Chronic Obstructive Pulmonary Disease: A Nested Case-Control Study. JAMA Intern Med. Published online January 02, 2018. PMID 29297057
  89. Janson C, Johansson G, Ställberg B, et al. Identifying the associated risks of pneumonia in COPD patients: ARCTIC an observational study. Respir Res 2018; 19(1): 172. pmid:30200965 PubMed
  90. Kew KM, Seniukovich A. Inhaled steroids and risk of pneumonia for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2014; 3: CD010115. doi: 10.1002/14651858.CD010115.pub2 DOI
  91. Leung JM, Niikura M, Yang CWT, Sin DD. COVID-19 and COPD. Eur Respir J. 2020 Aug 13;56(2):2002108. PMID: 32817205 PubMed
  92. Børvik T, Brækkan SK, Enga K, et al.. COPD and risk of venous thromboembolism and mortality in a general population. Eur Respir J 2016; 47(2): 473-81. pmid:26585434 PubMed
  93. Karlsson CA, Isaksson M, Janson C. Inhalationssteroider kan ge sekundär binjurebarkssvikt. Läkartidningen 2014; 111: CTAZ
  94. Edvardsen A, Akero A, Christensen CC, et al. Air travel and chronic obstructive pulmonary disease: a new algorithm for pre-flight evaluation. Thorax 2012 Jul 6. pmid:22767877 PubMed
  95. Pedone C, Scarlata S, Sorino C, Forastiere F, Bellia V, Antonelli Incalzi R. Does mild COPD affect prognosis in the elderly? BMC Pulm Med. 2010 Jun 7;10:35. PMID: 20529281 PubMed
  96. Helsedirektoratet. Nyheter. Gode brukererfaringer med medisinsk avstandsoppfølging (anm. red.: inkluderer kols). Publisert 22.01.2019 helsedirektoratet.no
  97. Walker PP, Pompilio PP, Zanaboni B, et al. Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial. Am J Respir Crit Care Med 2018; 198(5): 620-628. pmid:29557669 PubMed
Annonse
Annonse