Hyderabad: The habit of smoking is considered a major risk factor for various diseases such as Chronic Obstructive Pulmonary Disorder (COPD). But have you ever wondered why despite never smoking, some people, including women and the elderly, get respiratory disease called COPD?

COPD is a partial, non-reversible inflammation inside the breathing tube where the lumen of the breathing tube is narrowed permanently, more often than not. It is a more severe condition than asthma, and unlike asthma, it doesn’t bring relief with simple inhaler therapy.

COPD among non-smokers is now known to comprise one-third of all COPD patients globally. According to a new systematic review published online last month, in the journal ‘Respiratory Medicine,’ women and older adults are more likely to develop non-smoking COPD.

The Spanish study

A team of researchers from Spain conducted a systematic review of the literature to describe COPD among people who had never smoked through a search of Embase and PubMed databases. Non-smokers included those who had never smoked or if they had smoked, the number of cigarettes was less than 100 in their lifetime or less than one cigarette daily in the preceding six months. The final analysis included 17 clinical trials.

A total of 57,146 subjects were included in the analysis. Of these, 25,047 were never-smokers. Among the never-smokers, 2,655 had non-smoking COPD. Analysis of data showed that COPD among the non-smoking population was more common among women and older adults. They also had a higher preponderance of co-morbidities.

Biomass fuel - a major cause of COPD among women

This study shows the differences in COPD between never-smokers and smokers. The high prevalence among women, especially in low and middle-income countries, may be due to high exposure to indoor pollution due to biomass fuel. However, this review also brought out the lack of adequate evidence specifically regarding non-smoking COPD as just two of the 17 studies included in the analysis had an exclusive never-smoker study population.

Given that non-smoking COPD accounts for at least one-third of all COPD patients, there is an urgent need for further research to better comprehend the natural history and clinical features of the disease in this patient group compared to that in the ever-smokers.

Women and the elderly are more at risk

Elaborating on why non-smokers can also get COPD, Dr Yedlapati Gopi Krishna, a senior interventional pulmonologist at Yashoda Hospitals, Hitech City, says, “There are mainly five types of non-smoking COPD. In the elderly or aged people, the lungs get weaker and they develop senile COPD, which consists of 10% of non-smoking COPD cases. COPD is common among both urban and rural women due to pollution, burning certain types of fuel for cooking and inhaling second-hand smoke.”

“In rural areas, many women cook by burning wood, cow-dung cakes and other smoke-producing fuel in poorly ventilated areas. Inhalation of this smoke affects their lungs. Urban women too suffer from COPD either due to exposure to air pollution or due to second-hand smoking by their partners and friends,” adds Dr Gopi Krishna.

Apart from women and the elderly, occupational COPD also affects those who are exposed to pollutants for several years owing to their professions. “They include people like traffic constables, street vendors, workers in factories like jute mills, stone quarries etc. Even if they use masks, the prolonged exposure to pollution for years makes them vulnerable to COPD.”

“Around one per cent of young patients get COPD due to deficiency in Alpha 1 antitrypsin, an enzyme secreted by the liver. The fifth group of non-smokers who can get COPD are patients with existing asthma for decades but not using medicines optimally,” avers the pulmonologist.

Causes of non-smoking COPD at a glance

- Senile or age-related

- Deficiency of Alpha 1 antitrypsin liver enzyme

- Prolonged exposure to air pollution and smoke

- Burning of smoke-emanating fuel like wood

- Second-hand smoking

- Long-lasting asthma

COPD symptoms that should not be ignored

The common early symptoms of COPD include cough with sputum, breathlessness while walking, climbing or during any simple activity, extreme fatigue or weakness, loss of appetite, and becoming emaciated due to loss of muscles.

COPD can be controlled if not cured

“Measures to control COPD include early diagnosis, avoiding pollutants and irritants, taking flu and pneumococcal vaccines to reduce the infection rate and severity of the disease and pulmonary rehabilitation that consists of lung-related exercises,” says Dr Gopi Krishna.

Latest novel therapy brings hope for a cure

COPD has two forms – Bronchitis and Emphysema. The latter refers to the presence of large air bubbles in the lungs that compress normal lungs. “For such cases, we use Bronchoscopic Thermal Vapour Ablation (BTVA), whereby heated water vapour is passed in breathing tubes and closed so that the air bubbles collapse. We have treated around 50 patients in the last nine months using this endoscopic day care therapy and they have responded very well, so far bringing permanent relief to patients,” informs Dr Gopi Krishna.

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