COPD in Never Smokers

Abstract

Background:Never smokers comprise a substantial proportion of patients with COPD. Their characteristics and possible risk factors in this population are not yet well defined.Methods:We analyzed data from 14 countries that participated in the international, population-based Burden of Obstructive Lung Disease (BOLD) study. Participants were aged ≥ 40 years and completed postbronchodilator spirometry testing plus questionnaires about respiratory symptoms, health status, and exposure to COPD risk factors. A diagnosis of COPD was based on the postbronchodilator FEV1/FVC ratio, according to current GOLD (Global Initiative for Obstructive Lung Disease) guidelines. In addition to this, the lower limit of normal (LLN) was evaluated as an alternative threshold for the FEV1/FVC ratio.Results:Among 4,291 never smokers, 6.6% met criteria for mild (GOLD stage I) COPD, and 5.6% met criteria for moderate to very severe (GOLD stage II+) COPD. Although never smokers were less likely to have COPD and had less severe COPD than ever smokers, never smokers nonetheless comprised 23.3% (240/1,031) of those classified with GOLD stage II+ COPD. This proportion was similar, 20.5% (171/832), even when the LLN was used as a threshold for the FEV1/FVC ratio. Predictors of COPD in never smokers include age, education, occupational exposure, childhood respiratory diseases, and BMI alterations.Conclusion:This multicenter international study confirms previous evidence that never smokers comprise a substantial proportion of individuals with COPD. Our data suggest that, in addition to increased age, a prior diagnosis of asthma and, among women, lower education levels are associated with an increased risk for COPD among never smokers.

A Systematic Review of the Association between Pulmonary Tuberculosis and the Development of Chronic Airflow Obstruction in Adults

“…In the combined analysis of data obtained using the BOLD methodology in 14 countries, no association between AFO and a history of previous PTB was found [21]. In a multivariate analysis of 4,291 never-smokers, the OR was 1.47 (95% CI.…”

“…Foremost among these risk factors are tobacco (cigarette) smoking, biomass exposure, childhood lung infections and occupational exposures, including exposure to dust, gases and fumes [3]. The absence of a tobacco-smoking history occurs in over 20% of patients fulfilling the criteria for COPD by spirometry and has been reported in population-based studies from many countries, thereby demanding closer examination of the role of other factors in the development of COPD [4,21]. Whether TB should be added to the list of recognized exposures for the future development of COPD, is unclear.…”

Spirometric and hygienic criteria in recognition of occupational COPD in Poland – A retrospective analysis of medical records

“…On the other hand, never-smokers constitute a considerable part of those suffering from COPD. Lamprecht et al [3] have indicated that 27.7% of the people who suffered from COPD had never smoked, and in those cases other risk factors for the disease development, including occupational ones, play an important role. Marine et al, in the study of 3400 miners over a 10-year period, assessed an independent contribution of smoking and exposure to respirable dust to clinically significant measures of respiratory dysfunction.…”

“…Chronic obstructive pulmonary disease (COPD) is a cause of increasing morbidity and mortality in Poland and worldwide [1][2][3]. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines of 2016, it is a common preventable and treatable disease, which is characterized by an airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response to noxious particles or gases in the airways and in the lungs [1].…”

Prematurity and Early Childhood Infection of Lower Respiratory Tract as Risk Factors of Developing Chronic Obstructive Bronchopulmonary Pathology in Adults

“…However, in 3-11% of cases disease manifestation occurs at a younger age in non-smoking persons [3][4][5]. The causes of chronic bronchopulmonary pathology in the given group of patients are supposed to be such pathological factors as prematurity and a heavy course of lower respiratory tract infection (LRTI) acting in the perinatal period and during the first three years of life, and leading to the impairment of the lung growth and development [6,7].…”