Is the primary mechanism underlying COPD: inflammation or ischaemia?

The mechanisms underlying the majority of COPD cases have remained ill-defined. Cigarette smoke contains many toxic chemicals that certainly cause some inflammatory responses, but this article advances a hypothesis that the nicotine and similar compounds within the smoke acting as vasoconstrictors of bronchiolar arterioles may be more important via multiple small infarcts that eventually destroy lung tissue. The hypothesis can explain many of the known features of COPD and if accepted would significantly alter the approach to this condition.