Professional Documents
Culture Documents
Nonsmokers*
Distinct Demographic Profiles
Carolyn E. Behrendt, PhD
C tis,OPDemphysema,
most commonly refers to chronic bronchi-
and the subset of asthma char-
previous epidemiologic study2 of COPD in non-
smokers, prevalence is greater among women than
acterized by irreversible or partly reversible airflow men until the age of 60 years, when prevalence
obstruction.1 Although the majority of COPD occurs ceases to differ by sex. Neither urban residence nor
in current or former smokers, the disease also occurs occupational category is associated with COPD in
in persons who have never smoked. According to the nonsmokers.2 In the general population, COPD is
independently associated with smoking, age, and
*From Epidemiology, Pfizer Global Research and Development. asthma but not with atopy alone.3,4 In addition,
This work was performed at Pfizer La Jolla Laboratories, San
Diego, CA. genetic predisposition, environmental tobacco
Financial support was provided by Pfizer, Inc. smoke, air pollution, Helicobacter pylori infection,
Manuscript received October 7, 2004; revision accepted January and autoimmune thyroid disease have been pro-
29, 2005.
Reproduction of this article is prohibited without written permission posed as risk factors for COPD.59
from the American College of Chest Physicians (www.chestjournal. The possibility that risk factors for COPD differ
org/misc/reprints.shtml). according to the severity of disease has not been
Correspondence to: Carolyn Behrendt, PhD, 3413 Paseo del
Campo, Palos Verdes Estates, CA 90274; e-mail: carolynbehrendt@ investigated to date. Using data from a national
yahoo.com health examination, the current study identifies and
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compares risk factors for mild and moderate-to- COPD. In addition, long-term occupational exposure to airway
severe COPD among nonsmokers. irritants was considered likely for persons in the following
categories of longest held occupation: extractive or precision
production, farm or nursery work, cleaning or building services,
laborer, cook, and waiter. Income was analyzed using the poverty
index, a ratio of family income to the Census Bureau poverty
Materials and Methods threshold value for the calendar year.10
Spirometry
Statistical Analysis
In the Third National Health and Nutrition Examination Sampling weights were taken into account in all analyses
Survey (from 1988 to 1994), a representative sample of the (SUDAAN; Research Triangle Institute; Research Triangle Park,
civilian, noninstitutionalized population of the United States NC). Means and percentages were reported with their SEs.
consented to an interview (assessing demographic characteristics, Logistic regression analysis was used to identify independent risk
medical history, medication use, risk behaviors) and a medical factors. Variables found significant (p 0.05) in univariate anal-
examination (including spirometry and a battery of laboratory ysis were tested in multivariate analysis and retained if they
tests).10 Spirometry was conducted by a trained technician either improved the fit of the model. As suggested by published data2
in the mobile examination center or in the home of examinees and Figure 1, an interaction term for the effect of sex 60 years
aged 60 years who were unwilling or unable to come to the and 60 years was tested in the model of mild COPD.
center.10 Excluded from spirometry were examinees who had
undergone chest or abdominal surgery within 3 weeks or had
been hospitalized for myocardial infarction, chest pain, or con-
gestive heart failure within 6 weeks. Results
Study Sample
Study Population
Of the 16,238 examinees, aged 18 to 80 years and
Current subjects were white, black, or Mexican-American identified as white, black, or Mexican American,
examinees aged 18 to 80 years whose spirometry findings met the 95.4 0.3% underwent spirometry; of these,
reproducibility and reliability criteria of the American Thoracic 95.2 0.3% produced reproducible and reliable re-
Society11,12 and who provided data on smoking history and
height. The upper age limit for the study was chosen to accord
sults. After excluding 6 persons with acceptable
with formulas used to derive predicted values of FEV1 and spirometry who lacked data on smoking history or
FVC.13 height, eligibility criteria were met by 13,995 exam-
Most of the current analysis was restricted to nonsmokers, a inees, who represented 155.82 million adults nation-
group that included both lifelong nonsmokers of cigarettes, wide (female gender, 51.3 0.4%; mean age,
cigars, or pipe tobacco and former cigarette smokers with a 5
pack-year smoking history who had never smoked cigars or
42.2 0.4 years). Among this general sample, one
pipes.9 Pack-years of smoking were calculated taking into account half (48.7 0.9%) were nonsmokers (n 7,526),
not only the most recent level of daily smoking but also periods who represented 75.95 million adults (female gen-
of higher usage or abstinence. der, 63.2 0.8%; mean age, 40.1 0.4 years). A
Definitions
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mortality in the United States: data from the First National 22 Sandford AJ, Silverman EK. Chronic obstructive pulmonary
Health and Nutrition Examination Survey follow up study. disease: 1. Susceptibility factors for COPD, the genotype-
Thorax 2003; 58:388 393 environment interaction. Thorax 2002; 57:736 741
20 Snyder LD, Eisner MD. Obstructive lung disease among the 23 Montnemery P, Lanke J, Lindholm LH, et al. Familial related
urban homeless. Chest 2004; 125:1719 1725 risk-factors in the development of chronic bronchitis/emphy-
21 Bakke PS. Factors affecting growth of FEV1. Monaldi Arch sema as compared to asthma assessed in a postal survey. Eur
Chest Dis 2003; 59:103107 J Epidemiol 2000; 16:10031007
Downloaded From: http://journal.publications.chestnet.org/ by a Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas User on 07/27/2015
tory, current exposure to smoking in the home or income, or allergies (data not shown). Associations
workplace, urban residence, income, occupation, or between COPD and asthma (described above) did
education. not vary by age at asthma diagnosis.
Table 2Characteristics Independently Associated with Mild and Moderate-to-Severe COPD Among Nonsmokers
Aged 18 to 80 Years
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As the previous study reported for COPD in References
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Thorax 2003; 58:388 393 environment interaction. Thorax 2002; 57:736 741
20 Snyder LD, Eisner MD. Obstructive lung disease among the 23 Montnemery P, Lanke J, Lindholm LH, et al. Familial related
urban homeless. Chest 2004; 125:1719 1725 risk-factors in the development of chronic bronchitis/emphy-
21 Bakke PS. Factors affecting growth of FEV1. Monaldi Arch sema as compared to asthma assessed in a postal survey. Eur
Chest Dis 2003; 59:103107 J Epidemiol 2000; 16:10031007
Downloaded From: http://journal.publications.chestnet.org/ by a Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas User on 07/27/2015