1 Joan, Princess of Wales, in the 13th century, the wife and consort of Llywelyn the Great, the Prince of Wales; and the daughter of King John of England. Joan, Princess of Wales, in the 13th century, the wife and consort of Llywelyn the Great, the Prince of Wales; and the daughter of King John of England.
1 More than 90% of COPD deaths occur in low- and middle-income countries. 2  The primary cause of COPD is tobacco smoke (through tobacco use or second-hand smoke).  The disease now affects men and women almost equally, due in part to increased tobacco use among women in high-income countries.
Causes of emphysema. The biggest known cause or risk factor for emphysema-and for COPD-is smoking.4,6-8 Cigarette smoking is responsible for around 90% of cases of COPD.7 However, COPD will develop only in smokers who are genetically susceptible-smoking does not always lead to the disease.8. Smoking is the leading cause of emphysema.