COPD exacerbation rates are higher in non-smoker patients in India

• Published in: The international journal of tuberculosis and lung disease Vol. 24; no. 12; pp. 1272 - 1278
• Main Authors: Jindal, S. K., Aggarwal, A. N., Jindal, A., Talwar, D., Dhar, R., Singh, N., Singh, V., Krishnaswamy, U. M., Chetambath, R., Nath, A., Bhattacharya, P., Chaudhary, D., Gupta, P. R., Gupta, M. L., Koul, P., Swarankar, R., Kant, S., Ghoshal, A.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 01.12.2020; International Union against Tuberculosis and Lung Disease (IUATLD)
• Subjects: Biomass Fuels; Bronchodilator Agents - therapeutic use; Bronchodilators; C-reactive protein; Chronic obstructive pulmonary disease; Emergency medical services; Exposure; Female; Forced Expiratory Volume; Fuel combustion; Household Air Pollution; Humans; India - epidemiology; Lung diseases; Male; Nitric oxide; Non-Smokers; Obstructive lung disease; Patients; Phenotypes; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - epidemiology; Pulmonary functions; Radiography; Respiratory function; Smoking; Solid fuels; Sputum; Steroid hormones; India
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.20.0253

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is common among non-smokers exposed to solid fuel combustion at home. Different clinical characteristics in these patients may have significant therapeutic and prognostic implications.METHODS: We used medical record review and a questionnaire among COPD patients at 15 centres across India to capture data on demographic details, different types of exposures and clinical characteristics. Chest radiography and pulmonary function testing were performed in all 1984 cases; C-reactive protein and exhaled breath nitric oxide were measured wherever available.RESULTS: There were 1388 current or ex-smokers and 596 (30.0%) non-smokers who included 259 (43.5%) male and 337 (56.5%) female patients. Sputum production was significantly more common in smokers with COPD (P < 0.05). The frequency of acute symptomatic worsening, emergency visits and hospitalisation were significantly higher (P < 0.05) in non-smokers with COPD; however, intensive care unit admissions were similar in the two groups. There was no significant difference with respect to the use of bronchodilators, inhalational steroids or home nebulisation among smoker and non-smoker patients. The mean predicted forced expiratory volume in 1 sec in smokers (43.1%) was significantly lower than in non-smokers (46.5%).CONCLUSION: Non-smoker COPD, more commonly observed in women exposed to biomass fuels, was characterised by higher rate of exacerbations and higher healthcare resource utilisation.