COPD in the Never-Smoker

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

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Epidemiology of COPD in the Never-Smoker

As noted above, 15 to 20% of the COPD in the US population occurs in never-smokers. In a report from the Third National Health and Nutrition Examination Survey (NHANES III) 3.0 % of never-smokers had evidence of low lung function (FEV₁ < 80% predicted and FEV₁/FVC < 0.70).⁵ In that study, of the estimated 11.5 million adults with low lung function, 2.3 million (about 20%) had never smoked (Table 1).

Table 1—COPD in Never-Smokers*

Race/Sex	Population	Percentage With GOLD Stage 2 or 3 COPD	No. With GOLD Stage 2 or 3 COPD
Black/female	6,823,000	2.6	160,000
Black/male	3,771,000	4.8	116,000
White/female	41,120,000	3.1	1,396,000
White/male	26,010,000	3.3	680,000
Total	77,724,000	3.0	2,352,000
*Data from NHANES III.5

In NHANES III, reversibility testing was not done, so some people classified as having low lung function may have had asthma. Another recent study has shown that in COPD-related deaths in the United States in 1993, 17% occurred in never-smokers.¹⁰ In that study, a history of asthma was a strong risk factor for COPD-related mortality in the never-smoker (odds ratio, 13.9; 95% confidence interval, 6.09, 32.4).

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