COPD in Biomass exposed nonsmokers: a different phenotype

ABSTRACT

Introduction

Chronic obstructive pulmonary disease, most commonly caused by tobacco smoking, is increasingly reported in nonsmoking patients exposed to domestic combustion of biomass fuels. This is particularly common among rural women in the low- and middle-income countries. It is highly likely that the disease in these patients is a different clinical phenotype.

Areas covered

This manuscript covers epidemiological and clinical aspects of biomass-exposed COPD and also dwells upon its different phenotypic characteristics.

Expert opinion

Chronic obstructive pulmonary disease in biomass-exposed, nonsmoker patients which predominantly presents with features of chronic bronchitis is more likely a distinct phenotype with greater likelihood of small airway involvement.

KEYWORDS:

• Chronic obstructive pulmonary disease
• biomass fuels
• smoking
• domestic combustion
• Low and Middle Income
• phenotypes
• chronic bronchitis
• house-hold air pollution

Article highlights

• COPD is commonly seen among nonsmokers exposed to biomass fuel combustion in the low and middle-income countries.

• The disease in biomass-exposed patients is significantly more common in women living in the rural areas.

• There are a few differences in clinical features of COPD seen in biomass-exposed patients from those of smoker-COPD. They are younger in age.

• Biomass-exposed COPD patients suffer from more frequent acute exacerbations and require more frequent hospitalizations.

• Radiologically, these patients show more of bronchial wall thickening suggestive of small airway involvement.

• Lung function of nonsmoker patients is better preserved than smoker-COPD.

• These patients show greater degree of airway inflammation with variably reported cellular and mediator release.

• COPD in biomass-exposed patients is likely a distinct clinical phenotype with more suggestive features of small airway disease.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.