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COPD in the Never-Smoker

By David M. Mannino, MD, FCCP; and Kathryn Marie McGonigle

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Objectives

  1. Identify never-smokers as an important subset of the COPD population.
  2. Discuss the relationship between asthma and COPD.
  3. Understand the genetic components of COPD.
  4. Identify occupational risk factors for COPD.
  5. Discuss prevention methods for COPD in the never-smoker.

Key words

asthma; COPD; genetics; never-smoker; occupation; risk factors

Abbreviations

DALY = disability-adjusted life-year; GOLD = Global Initiative for Chronic Obstructive Lung Disease; IL = interleukin; NHANES III = Third National Health and Nutrition Examination Survey; TNF-α = tumor necrosis factor-α

Definition of COPD

Several different definitions have traditionally existed for COPD.1,2 The recently published and widely accepted definition from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) has classified COPD as "a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases."3 This definition, which depends on physiologic changes rather than a clinical diagnosis, makes it much easier to classify never-smokers as having COPD. The subtypes of COPD (asthmatic, bronchitic, and emphysematous) may have both different etiologies and outcomes, along with different treatment strategies.

Airflow limitation is the slowing of expiratory airflow as measured by spirometry, with a persistently low FEV1 and a low FEV1/FVC ratio despite treatment. The GOLD definition for airflow limitation is an FEV1/FVC ratio of < 70%. Airflow limitation reversibility can be spontaneous, in response to an inhaled bronchodilator, or in response to oral or inhaled corticosteroids. The GOLD definition of COPD classifies reversibility as an FEV1 increase of 200 mL and 12% improvement above baseline FEV1.3 While COPD has been closely linked to cigarette smoking in the developed world, smoking has never been part of any definition of COPD, although it typically enters into clinicians’ decision making.

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