Understanding COPD in Non-Smokers

Patient consulting Doctor for breathing difficulties, Asthma
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If you have lived your life as a never-smoker and are surprised to learn that you have COPD, you may be wondering just what you did, or did not do, to deserve such a disease. The startling fact is, the statistics surrounding COPD in the never-smoker are significant and much more common that many of us would like to think.

Just how many people diagnosed with COPD have never smoked, and how does someone like this acquire the disease?


The following are a number of statistics associated with COPD and the never-smoker.

According to data from the Third National Health and Nutrition Examination Survey, between 1988 and 1994, of those Americans who had COPD, 24.9 percent (plus or minus 1.4 percent) never smoked. The United Kingdom and Spain reported similar findings of 22.9 percent and 23.4 percent, respectively.

An international population-based study published in CHEST suggested that never-smokers were found to be far less likely to have COPD out of a study population of 4,291 participants (and if they did, it was generally less severe). However, 5.6 percent, or 240 never-smokers, still had the equivalent of GOLD Stage II+ COPD. The same study looked at a combined group of 1,031 smokers and never-smokers alike who had GOLD Stage II+ COPD, and of this group, 23.3 percent had never smoked.

The American Journal of Medicine reports that there are 4.6 million never-smokers in the United States alone who have spirometric evidence of obstructive airway disease. Because airway reversibility after using a bronchodilator was not assessed in this study, it was unclear whether the airway obstruction was due to COPD or asthma.

So, what places those who have never smoked at greater risk for COPD?

Risk Factors in the Never-Smoker

While cigarette smoking remains the primary cause of COPD, in the never-smoker, the following risk factors are thought to influence a diagnosis:

  • Increased age
  • A prior diagnosis of asthma
  • A lower education level (among women only)


There is increasing evidence that suggests that factors influencing lung growth in the womb or during early childhood development (such as low birth weight or childhood lung infections) may also increase the risk of COPD in certain individuals. In addition, there are several other causes that may contribute to a COPD diagnosis in those who have never smoked:

Does COPD Affect Never-Smokers Differently?

The answer to this question is yes and no. Once diagnosed, the disease runs the same, irreversible course; however, in never-smokers, the disease may be somewhat unrecognizable because doctors won't think to look for it. The disease will also progress more rapidly in those who continue to smoke as opposed to those who don't.

Additionally, while COPD symptoms will undoubtedly be similar in the smoker and non-smoker alike, treatment options will be slightly different. This is because for the smoker, quitting is the number one goal of treatment. Thankfully, never-smokers don't have to worry about quitting; therefore, treatment options will focus on medication and a balanced diet and exercise program.

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