The pathophysiology of COPD is not fully understood but researchers and doctors have come up with a few theories; one being connected to airway inflammation. The inhaled irritants cause inflammatory cells such as neutrophils, CD8* T-lymphocytes, B cells, and macrophages to accumulate. When these cells are activated they initiate an inflammatory cascade triggering the release of inflammatory mediators such as tumor necrosis factor alpha, interferon gamma, matrix-metalloproteinases, C-reactive protein, interleukins, and fibrinogen. These inflammatory mediators sustain the inflammatory process and lead to tissue damage as well as a range of systemic effects. As I stated earlier, this is not the full development of the pathophysiology or COPD just the start of it.