In the JournalsPerspective

COPD in nonsmokers, smokers share similar prevalence by US region

There is a strong correlation between the state-level incidences of COPD in both nonsmoking and currently smoking populations, indicating that in certain U.S. regions, nonsmoking adults are more likely to be exposed to secondhand smoke, according to a study published in MMWR.

“Cigarette smoking is the leading cause of COPD in the United States,” the researchers wrote. “However, an estimated one-fourth of adults with COPD have never smoked. CDC analyzed state-specific Behavioral Risk Factor Surveillance System data from 2017, which indicated that, overall among U.S. adults, 6.2% (age-adjusted) reported having been told by a health care professional that they had COPD.”

Researchers analyzed data from 418,378 adult respondents to the 2017 Behavioral Risk Factor Surveillance System Survey.

Participants were asked the question, “Has a doctor, nurse or other health professional ever told you that you had chronic obstructive pulmonary disease, or COPD, emphysema or chronic bronchitis,” followed by a question about their smoking behavior.

“Persons were considered to have never smoked if they reported never smoking or smoked less than 100 cigarettes during their lifetime,” the researchers wrote. “Former smokers had smoked at least 100 cigarettes in their life but were not current smokers. Current smokers had smoked at least 100 cigarettes and currently smoked some days or every day.”

Researchers found that the overall age-adjusted prevalence of COPD was 6.2% in 2017, according to the study. COPD patterns were found to be similar, regardless of the individual being a nonsmoker, former or current smoker.

Among current smokers, the prevalence of COPD was 15.2% and varied from 4.7% in Hawaii to 25.9% in West Virginia.

Among former smokers, COPD prevalence was 7.6%, ranging between 4.7% in Hawaii and 15.1% in West Virginia.

Lastly, among nonsmokers, COPD prevalence was 2.8% and varied from 1.6% in Minnesota and 6% in West Virginia.

“The current report shows that geographic patterns of COPD prevalence are similar among current smokers, former smokers and adults who never smoked and correspond with patterns of smoking,” Anne G. Wheaton, PhD, of the CDC’s division of population health, epidemiology and surveillance branch, told Healio Pulmonology. “Although this was expected among current and former smokers, this finding among adults who never smoked suggests potential secondhand smoke exposure as a risk factor for COPD.”

The researchers concluded that population-based methods for smoking control and prevention could potentially decrease the prevalence of COPD. They stated that these methods could include tobacco product price increases, mass media antismoking campaigns and barrier-free access to evidence-based cessation interventions.

“Clinicians should be mindful that not all COPD is necessarily caused by smoking and should use spirometry for diagnosis in patients with COPD symptoms, regardless of their smoking history,” Wheaton said. “Population based strategies for tobacco prevention and control, including comprehensive smoke-free policies, have the potential to decrease COPD prevalence, including among nonsmokers.” – by Scott Buzby

Disclosure: Wheaton reports no relevant financial disclosures.

There is a strong correlation between the state-level incidences of COPD in both nonsmoking and currently smoking populations, indicating that in certain U.S. regions, nonsmoking adults are more likely to be exposed to secondhand smoke, according to a study published in MMWR.

“Cigarette smoking is the leading cause of COPD in the United States,” the researchers wrote. “However, an estimated one-fourth of adults with COPD have never smoked. CDC analyzed state-specific Behavioral Risk Factor Surveillance System data from 2017, which indicated that, overall among U.S. adults, 6.2% (age-adjusted) reported having been told by a health care professional that they had COPD.”

Researchers analyzed data from 418,378 adult respondents to the 2017 Behavioral Risk Factor Surveillance System Survey.

Participants were asked the question, “Has a doctor, nurse or other health professional ever told you that you had chronic obstructive pulmonary disease, or COPD, emphysema or chronic bronchitis,” followed by a question about their smoking behavior.

“Persons were considered to have never smoked if they reported never smoking or smoked less than 100 cigarettes during their lifetime,” the researchers wrote. “Former smokers had smoked at least 100 cigarettes in their life but were not current smokers. Current smokers had smoked at least 100 cigarettes and currently smoked some days or every day.”

Researchers found that the overall age-adjusted prevalence of COPD was 6.2% in 2017, according to the study. COPD patterns were found to be similar, regardless of the individual being a nonsmoker, former or current smoker.

Among current smokers, the prevalence of COPD was 15.2% and varied from 4.7% in Hawaii to 25.9% in West Virginia.

Among former smokers, COPD prevalence was 7.6%, ranging between 4.7% in Hawaii and 15.1% in West Virginia.

Lastly, among nonsmokers, COPD prevalence was 2.8% and varied from 1.6% in Minnesota and 6% in West Virginia.

“The current report shows that geographic patterns of COPD prevalence are similar among current smokers, former smokers and adults who never smoked and correspond with patterns of smoking,” Anne G. Wheaton, PhD, of the CDC’s division of population health, epidemiology and surveillance branch, told Healio Pulmonology. “Although this was expected among current and former smokers, this finding among adults who never smoked suggests potential secondhand smoke exposure as a risk factor for COPD.”

The researchers concluded that population-based methods for smoking control and prevention could potentially decrease the prevalence of COPD. They stated that these methods could include tobacco product price increases, mass media antismoking campaigns and barrier-free access to evidence-based cessation interventions.

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“Clinicians should be mindful that not all COPD is necessarily caused by smoking and should use spirometry for diagnosis in patients with COPD symptoms, regardless of their smoking history,” Wheaton said. “Population based strategies for tobacco prevention and control, including comprehensive smoke-free policies, have the potential to decrease COPD prevalence, including among nonsmokers.” – by Scott Buzby

Disclosure: Wheaton reports no relevant financial disclosures.

    Perspective
    Megan M. Dulohery Scrodin

    Megan M. Dulohery Scrodin

    Cigarette smoking has been a long-standing risk factor for the development of COPD. This report identified that up to one-quarter of patients who self-report a diagnosis of COPD are never smokers.  There were higher rates of COPD in smokers and nonsmokers in states where smoking prevalence was high. This finding suggests that exposure to secondhand smoke is a potential risk factor for COPD development. This study was based on patient-reported diagnosis of COPD, so further studies will need to be completed to understand the link between secondhand smoke exposure and the development of COPD. This report could not take into account other potential COPD risk factors (occupational exposures, air pollution, chronic asthma) to explain the prevalence of COPD in nonsmokers. Physicians should continue to offer smoking cessation support to all patients. Physicians should also consider secondhand smoke exposure when evaluating patients with respiratory symptoms.

    COPD diagnosis is determined by respiratory symptoms and pulmonary function testing that demonstrates fixed airway obstruction. This report would suggest that pulmonologists should consider a diagnosis of COPD in patients with first or secondhand smoke exposure. Pulmonary function testing can help to differentiate COPD from other respiratory disorders.

    This report demonstrates the continued need for public health strategies to reduce not only tobacco use but also secondhand smoke exposure. Access to smoking cessation programs and therapies is essential to helping promote smoking cessation. Smoke-free laws can also help to protect nonsmokers from secondhand smoke exposure.

    • Megan M. Dulohery Scrodin, MD
    • Division of Pulmonary and Critical Care Medicine at Mayo Clinic

    Disclosures: Dulohery Scrodin reports no relevant financial disclosures.