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      COPD in Never Smokers : Results From the Population-Based Burden of Obstructive Lung Disease Study

      , MD, , MD, , MD, , MD, FCCP, , MD, , MD, FCCP, , MD, FCCP, , MD, , MD, , MD, , MD, FCCP, , MD, for the BOLD Collaborative Research Group *

      Chest

      American College of Chest Physicians

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          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 FEV 1/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 FEV 1/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 FEV 1/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.

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          Most cited references 39

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          Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study

          Plausible projections of future mortality and disability are a useful aid in decisions on priorities for health research, capital investment, and training. Rates and patterns of ill health are determined by factors such as socioeconomic development, educational attainment, technological developments, and their dispersion among populations, as well as exposure to hazards such as tobacco. As part of the Global Burden of Disease Study (GBD), we developed three scenarios of future mortality and disability for different age-sex groups, causes, and regions. We used the most important disease and injury trends since 1950 in nine cause-of-death clusters. Regression equations for mortality rates for each cluster by region were developed from gross domestic product per person (in international dollars), average number of years of education, time (in years, as a surrogate for technological change), and smoking intensity, which shows the cumulative effects based on data for 47 countries in 1950-90. Optimistic, pessimistic, and baseline projections of the independent variables were made. We related mortality from detailed causes to mortality from a cause cluster to project more detailed causes. Based on projected numbers of deaths by cause, years of life lived with disability (YLDs) were projected from different relation models of YLDs to years of life lost (YLLs). Population projections were prepared from World Bank projections of fertility and the projected mortality rates. Life expectancy at birth for women was projected to increase in all three scenarios; in established market economies to about 90 years by 2020. Far smaller gains in male life expectancy were projected than in females; in formerly socialist economies of Europe, male life expectancy may not increase at all. Worldwide mortality from communicable maternal, perinatal, and nutritional disorders was expected to decline in the baseline scenario from 17.2 million deaths in 1990 to 10.3 million in 2020. We projected that non-communicable disease mortality will increase from 28.1 million deaths in 1990 to 49.7 million in 2020. Deaths from injury may increase from 5.1 million to 8.4 million. Leading causes of disability-adjusted life years (DALYs) predicted by the baseline model were (in descending order): ischaemic heart disease, unipolar major depression, road-traffic accidents, cerebrovascular disease, chronic obstructive pulmonary disease, lower respiratory infections, tuberculosis, war injuries, diarrhoeal diseases, and HIV. Tobacco-attributable mortality is projected to increase from 3.0 million deaths in 1990 to 8.4 million deaths in 2020. Health trends in the next 25 years will be determined mainly by the ageing of the world's population, the decline in age-specific mortality rates from communicable, maternal, perinatal, and nutritional disorders, the spread of HIV, and the increase in tobacco-related mortality and disability. Projections, by their nature, are highly uncertain, but we found some robust results with implications for health policy.
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            Chronic obstructive pulmonary disease in non-smokers.

            Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Tobacco smoking is established as a major risk factor, but emerging evidence suggests that other risk factors are important, especially in developing countries. An estimated 25-45% of patients with COPD have never smoked; the burden of non-smoking COPD is therefore much higher than previously believed. About 3 billion people, half the worldwide population, are exposed to smoke from biomass fuel compared with 1.01 billion people who smoke tobacco, which suggests that exposure to biomass smoke might be the biggest risk factor for COPD globally. We review the evidence for the association of COPD with biomass fuel, occupational exposure to dusts and gases, history of pulmonary tuberculosis, chronic asthma, respiratory-tract infections during childhood, outdoor air pollution, and poor socioeconomic status.
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              • Record: found
              • Abstract: not found
              • Article: not found

              Immunologic aspects of chronic obstructive pulmonary disease.

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                Author and article information

                Journal
                Chest
                chest
                chest
                Chest
                Chest
                American College of Chest Physicians
                0012-3692
                1931-3543
                April 2011
                26 March 2011
                26 March 2011
                : 139
                : 4
                : 752-763
                Affiliations
                From the Department of Pulmonary Medicine (Drs Lamprecht and Studnicka), Paracelsus Medical University, Salzburg, Austria; the Kaiser Permanente Center for Health Research (Drs McBurnie and Vollmer), and the Oregon Health and Science University (Dr Buist), Portland, OR; the Department of Respiratory Medicine, Allergy, and Sleep (Dr Gudmundsson), Landspitali University Hospital, Reykjavik, Iceland; the Department of Respiratory Medicine (Dr Welte), Hannover Medical University, Hannover, Germany; the Department of Medicine (Dr Nizankowska-Mogilnicka), Jagiellonian University School of Medicine, Krakow, Poland; the University of Cape Town (Dr Bateman), Cape Town, South Africa; the Centre for Research in Environmental Epidemiology (Dr Anto), Barcelona, Spain; the Department of Public Health Sciences (Dr Burney), King’s College London, London, England; and the University of Kentucky (Dr Mannino), Lexington, KY.
                Author notes
                Correspondence to: Bernd Lamprecht, MD, Paracelsus Medical University, Department of Pulmonary Medicine, Müllner Hauptstraße 48, 5020 Salzburg, Austria; e-mail: b.lamprecht@ 123456salk.at
                Article
                101253
                10.1378/chest.10-1253
                3168866
                20884729
                © 2011 American College of Chest Physicians

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial License ( http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Information for commercial entities is available online ( http://www.chestpubs.org/site/misc/reprints.xhtml).

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                Original Research
                COPD

                Respiratory medicine

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