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Anne G. Wheaton, PhD, on COPD Prevalence in Smokers

Cigarette smoking is a well-known cause of chronic obstructive pulmonary disease (COPD), but 25% of adults with COPD have never smoked. A new review examined COPD and smoking status in the United States in 2017.1

The research team was led by Anne G. Wheaton, PhD, who is an epidemiologist at the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. We caught up with Dr Wheaton about the report; here are her answers to our burning questions.

PULMONOLOGY CONSULTANT: Your research investigated the geographic and sociodemographic patterns of COPD in the United States. Can you tell us more about your research and how it came about?

Anne Wheaton: Our group has previously analyzed CDC surveillance data to assess geographic and sociodemographic patterns of COPD. We had previously shown that most adults with COPD have a history of cigarette smoking but that a quarter of adults with COPD have never smoked. In addition, certain groups—women, American Indians/Alaska Natives, those with less education, and adults with a history of asthma—were more likely to have COPD. We had also observed a higher COPD prevalence in southeastern and Appalachian states. However, we did not separate adults who had a smoking history from those who have never smoked. For our latest report, we repeated our analyses but evaluated current smokers, former smokers, and those who had never smoked separately, to see if different groups were at risk by smoking status. 

PULM CON: In terms of findings, in which geographic areas was COPD prevalence highest? In which areas was it lowest? Why do you think that is?

AW: In our recent report, higher prevalence of COPD were observed in southeastern and Appalachian states, regardless of the smoking status of respondents. We found a strong correlation between state-level prevalence of COPD among adults who never smoked and state-level prevalence of current smoking. This suggests that in certain regions, adults who never smoked might be more likely to be exposed to secondhand smoke. Among the states in the highest quartile for COPD among adults who never smoked, only New Jersey had laws banning smoking in private worksites, restaurants, and bars; the remainder of states in that quartile either had no smoke-free laws or laws banning smoking in only one or two venues. We could not evaluate survey respondents’ exposure to secondhand smoke or other pollutants that might contribute to COPD risk. The same regions that have higher COPD prevalence also tend to have higher prevalence of other chronic conditions and risk behaviors, as well as lower socioeconomic status. Our study used cross-sectional data, so we could not assess causality for any of these possible explanations.

PULM CON: How might these results impact clinical practice?

AW: Clinicians need to keep in mind that a significant proportion of adults with COPD have never smoked. In order to slow the progression of COPD, early detection and treatment is important. Consider COPD in symptomatic patients, regardless of smoking history.

PULM CON: What is the next step in this research? What else are you investigating?

AW: Another CDC group from the NIOSH (National Institute for Occupational Safety and Health) recently published a report on COPD among adults who have never smoked by industry and occupation.2 Since the prevalence of COPD is now higher among women and more women are dying from COPD than men, we plan to look at COPD among women in more detail.

PULM CON: What is the key take-home message for pulmonologists and public health professionals?

AW: Clinicians should be mindful that not all COPD is necessarily caused by smoking and should use spirometry for diagnosing COPD in patients with symptoms, regardless of their smoking history. Population-based strategies for smoking prevention and control, including comprehensive smoke-free policies, have the potential to decrease COPD prevalence, including among nonsmokers.

References:

  1. Wheaton AG, Liu Y, Croft JB, et al. Chronic obstructive pulmonary disease and smoking status – United States, 2017. MMWR Morb Mortal Wkly Rep. 2019;68(24):533-538. https://doi.org/10.15585/mmwr.mm6824a1.
  2. Syamlal G, Doney B, Mazurek JM. Chronic obstructive pulmonary disease prevalence among adults who have never smoked, by industry and occupation – United States, 2017. MMWR Morb Mortal Wkly Rep. 2019;68(13):303-307. https://doi.org/10.15585/mmwr.mm6813a2.