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.
| Original language | English |
|---|---|
| Pages (from-to) | 752-763 |
| Number of pages | 12 |
| Journal | Chest |
| Volume | 139 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Apr 2011 |
Bibliographical note
Funding Information:Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr McBurnie received funding for the BOLD study operations center and/or other research from unrestricted educational grants from GlaxoSmithKline, Pfizer, Boehringer Ingelheim, AstraZeneca, ALTANA, Novartis, Merck, Chiesi, Schering Plough, and Sepracor. Dr Vollmer has served on ad hoc advisory boards for Merck and Co; has participated in COPD workshops funded by Merck and GlaxoSmithKline; and is director of the Burden of Obstructive Lung Disease (BOLD) Operations Center, for which funding includes unrestricted educational grants to the Kaiser Permanente Center for Health Research from Boehringer Ingelheim, Pfizer, ALTANA, GlaxoSmithKline, AstraZeneca, Novartis, Chiesi, and Merck. Dr Anto has received an educational grant from AstraZeneca, Spain. Dr Mannino has received research funding from GlaxoSmithKline, Pfizer, and Novartis. He has served as a speaker, advisor, or consultant for AstraZeneca, MAP, Dey, Seprecor, Boehringer-Ingelheim, GlaxoSmithKline, Pfizer, and Novartis. He has also served as an expert witness in active and passive smoking cases. Dr Buist is a member of Advisory Boards for AstraZeneca, GlaxoSmithKline, Merck, and Novartis and has received unrestricted educational grants to the BOLD Operations Center from Chiesi, Boehringer Ingelheim, Pfizer, Novartis, GlaxoSmithKline, Sepracor, and Merck. Drs Lamprecht, Gudmundsson, Welte, Nizankowska-Mogilnicka, Studnicka, Bateman, and Burney have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Other keywords
- Adult
- Aged
- Aged, 80 and over
- Female
- Humans
- Incidence
- Male
- Middle Aged
- Pulmonary Disease, Chronic Obstructive
- Questionnaires
- Respiratory Function Tests
- Retrospective Studies
- Risk Factors
- Smoking
- World Health