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COPD in the Never-Smoker

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

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Pathogenesis of COPD in the Never-Smoker

Factors responsible for the development of COPD in the never-smoker are still being defined. The COPD model that has been applied in smokers (Fig 1) probably remains accurate in never-smokers. Because the “noxious particles and gases” stimulus (tobacco smoke in smokers) is much less in never-smokers, reviewing COPD in never-smokers may provide a better understanding of how the other modifying factors work together to cause in COPD. The role of intrinsic factors (asthma and bronchial responsiveness, genetics, sex, aging) and extrinsic factors (infections, air pollution, nutrition, occupational exposures, pediatric exposures) in the development and progression of COPD in the never-smoker will now be explored.

Figure 1. Pathogenesis of COPD. From GOLD.3

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