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. 2016 Mar 24;11(3):e0151981.
doi: 10.1371/journal.pone.0151981. eCollection 2016.

COPD in Nonsmokers: Reports from the Tunisian Population-Based Burden of Obstructive Lung Disease Study

Meriam Denguezli  1 , Hager Daldoul  1 , Imed Harrabi  2 , Louisa Gnatiuc  3 , Sonia Coton  3 , Peter Burney  3 , Zouhair Tabka  1
Affiliations

COPD in Nonsmokers: Reports from the Tunisian Population-Based Burden of Obstructive Lung Disease Study

Meriam Denguezli et al. PLoS One. .

Abstract

Background: It's currently well known that smoking and increasing age constitute the most important risk factors for chronic obstructive pulmonary disease (COPD). However, little is known about COPD among nonsmokers. The present study aimed to investigate prevalence, risk factors and the profiles of COPD among nonsmokers based on the Tunisian Burden of Obstructive Lung Disease (BOLD) study.

Methods: 807 adults aged 40 years+ were randomly selected from the general population. We collected information about history of respiratory disease, risk factors for COPD and quality of life. Post-bronchodilator spirometry was performed for assessment of COPD. COPD diagnostic was based on the post-bronchodilator FEV1/FVC ratio, according to the Global Initiative for Obstructive Lung Disease (GOLD) guidelines. The lower limit of normal (LLN) was determined as an alternative threshold for the FEV1/FVC ratio.

Results and conclusions: Among 485 nonsmokers, 4.7% met the criteria for GOLD grade I and higher COPD. These proportions were similar even when the LLN was used as a threshold. None of the nonsmokers with COPD reported a previous doctor diagnosis of COPD compared to 7.1% of smokers. Nonsmokers accounted for 45.1% of the subjects fulfilling the GOLD spirometric criteria of COPD. Nonsmokers were predominately men and reported more asthma problems than obstructed smokers. Among nonsmokers significantly more symptoms and higher co-morbidity were found among those with COPD. Increasing age, male gender, occupational exposure, lower body mass index and a previous diagnosis of asthma are associated with increased risk for COPD in nonsmokers. This study confirms previous evidence that nonsmokers comprise a substantial proportion of individuals with COPD. Nonsmokers with COPD have a specific profile and should, thus, receive far greater attention to prevent and treat chronic airway obstruction.

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Conflict of interest statement

Competing Interests: The authors have the following interests: Additional local support for BOLD sites was provided by Boerhinger Ingelheim (Sousse, Tunisia). There are no patents, products in development or marketed products to declare. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Prevalence (%) of COPD in smokers and nonsmokers respectively by disease severity.
COPD: Chronic Obstructive Pulmonary Disease; GOLD I: Global Initiative for Chronic Obstructive Lung Disease Stage I COPD; *: p<0.01, Significant difference between smokers and nonsmokers.
Fig 2
Fig 2. Prevalence of COPD (GOLD I and higher COPD) by gender and age groups.
Chronic Obstructive Pulmonary Disease; GOLD I: Global Initiative for Chronic Obstructive Lung Disease Stage I COPD; *: p<0.01, Significant difference between male and female according to age.
Fig 3
Fig 3. Population characteristics of male smokers and nonsmokers.
COPD: Chronic Obstructive Pulmonary Disease; GOLD I: Global Initiative for Chronic Obstructive Lung Disease Grade I COPD; GOLD II: Global Initiative for Chronic Obstructive Lung Disease Grade II COPD.
Fig 4
Fig 4. Population characteristics of female smokers and nonsmokers.
COPD: Chronic Obstructive Pulmonary Disease; GOLD I: Global Initiative for Chronic Obstructive Lung Disease Grade I COPD; GOLD II: Global Initiative for Chronic Obstructive Lung Disease Grade II COPD.
See this image and copyright information in PMC

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