A Cross-Sectional Study on Copd in Non-Smokers at King George Hospital in Visakhapatnam, India

Chronic Obstructive Pulmonary Disease (COPD) is a prevalent and significant respiratory condition characterized by persistent respiratory symptoms and airflow limitation, often attributed to airway or alveolar abnormalities resulting from exposure to noxious particles or gases 1 . Despite the strong association between COPD and smoking, an estimated 25-45% of individuals diagnosed with COPD have never smoked2. This indicates that the prevalence of non-smoking-related COPD is higher than previously believed, highlighting the importance of understanding this subset of the disease. However, there is a scarcity of studies focusing on COPD in non-smokers, which underscores the need for further research in this area. COPD is not only a leading cause of mortality but is also a growing contributor to chronic disability globally. Predictions suggest that by 2020, COPD will become the fifth most common cause of chronic disability worldwide. Recent projections by the World Health Organization indicate that COPD is expected to climb in the ranks of leading causes of death becoming the fourth most common cause by 20303. The global burden of COPD is substantial, with an estimated 251 million people affected in 2016, and approximately 3.17 million deaths attributed to the disease in 2015, representing 5% of all global deaths that year4. Notably, the majority of COPD-related deaths occur in developing countries, highlighting the global impact of the disease. Chronic obstructive pulmonary disease (COPD) is caused by long term exposure to cigarette smoking and affects up to 25% of smokers. But emerging evidence suggests that other risk factors are important, especially in developing countries like environmental tobacco smoke, exposure to biomass fuel, genetic factors, outdoor air pollution, pulmonary tuberculosis, poorly treated asthma, poor nourishment and repeated lower respiratory tract infections during childhood. Others include age, male gender and low socioeconomic status5. In severe and very severe COPD patients, systemic inflammation and skeletal muscle wasting as a result of weight loss and anorexia are commonly seen It contributes to limitation of the exercise capacity of patients, affecting the quality of life and worsens the prognosis irrespective of the severity of airflow obstruction6. The seriousness of dyspnea reported by the patients is usually correlational to the severity of lung function. COPD is confirmed by spirometry when the FEV1/FVC ratio is < 0.70. Although there is some controversy regarding the cut-off values, both the GOLD guidelines and the combined American College of Physicians, American College of Chest Physicians, American Thoracic Society and the European Respiratory Society COPD guidelines recommend using the fixed cut off of <0.70. To simplify the diagnosis of COPD, the above criterion is set regardless of age and gender. Slow Vital Capacity may be used as a tool of diagnosis in elderly patients who are unable to perform a Forced Vital Capacity (FVC) test without cough7,8,9. So, this study is conducted to study the clinical profile of COPD and the associated risk factors in non-smokers.