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Chronic obstructive pulmonary disease in non-smokers
Sundeep S Salvi1, Peter J Barnes
1Chest Research Foundation, Pune, India. ssalvi@crfindia.com
Lancet (London, England)
|September 1, 2009
Summary
Biomass smoke exposure may be the leading global cause of Chronic Obstructive Pulmonary Disease (COPD), affecting billions. This review examines various COPD risk factors beyond tobacco smoking, including biomass fuel, occupational exposures, and infections.
Area of Science:
- Pulmonary Medicine
- Environmental Health
- Epidemiology
Background:
- Chronic Obstructive Pulmonary Disease (COPD) is a significant global health burden, causing widespread morbidity and mortality.
- While tobacco smoking is a primary risk factor, a substantial proportion of COPD cases, particularly in developing nations, occur in never-smokers.
- This highlights the importance of identifying and understanding non-traditional COPD risk factors.
Purpose of the Study:
- To review and synthesize evidence on the association between various environmental and occupational exposures and the development of COPD.
- To emphasize the significant role of biomass fuel smoke as a potential leading global risk factor for COPD.
- To explore other contributing factors such as occupational dusts, infections, and air pollution.
Main Methods:
- Systematic review of existing epidemiological studies and scientific literature.
- Analysis of global population data on exposure to biomass fuel smoke versus tobacco smoking.
- Evidence synthesis of associations between COPD and factors including biomass smoke, occupational exposures, childhood infections, asthma, and air pollution.
Main Results:
- An estimated 25-45% of COPD patients have never smoked, indicating a high burden of non-smoking COPD.
- Approximately 3 billion people are exposed to biomass fuel smoke, potentially making it the most significant global COPD risk factor.
- Associations were reviewed for biomass fuel, occupational exposures, tuberculosis history, asthma, childhood respiratory infections, outdoor air pollution, and socioeconomic status.
Conclusions:
- Biomass fuel smoke exposure is a critical, under-recognized risk factor for COPD globally.
- Non-smoking related COPD is highly prevalent, necessitating a broader understanding of risk factors.
- Public health strategies should address biomass smoke exposure, especially in developing countries, to mitigate the global COPD burden.
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