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We all "know" that smoking causes chronic obstructive pulmonary disease (COPD), but the fact is some non-smokers develop the condition, and some smokers do not. What makes the difference?
Smoking is the main cause of COPD, and smoking cessation is the best way to stop the progression of the disease for most people. That leaves the open question, why do non-smokers ever develop COPD at all?
Research in China has traced a number of factors to the development of COPD in people who have never smoked. In the People's Republic of China, over 8 percent of the population has the disease, but 27 percent of people with COPD never smoked, and of this group, about 70 percent are women. The factors that predispose non-smokers to chronic pulmonary problems include:
- Exposure to smoke, particularly from cooking fires. Women who prepare meals over wood or kerosene stoves and men who are cooks in restaurants are at special risk for COPD, because of the particulate matter in the smoke.
- People who lived in houses heated by coal fires without chimneys are at special risk of developing COPD. Installing chimneys reduces the risk of COPD.
- People who lived in the dustier cities of western China were more susceptible to COPD than people who lived in Shanghai.
People in other parts of the world, of course, aren't as likely to heat their homes with coal fires in the middle of the floor or to cook over wood and kerosene. Surely they don't develop COPD as often as people in China, one might think.
However, COPD is actually more common in Europe than in China. One study found higher rates of emphysema in the Netherlands than in China. The reason for those higher rates could not be electric stoves and steam heat during winter, so what would the common factors in Europe be?
- People in Europe who develop COPD are more likely to have had serious respiratory infections as children.
- People in Europe who develop COPD are more likely to have started smoking before the age of 18.
- People in Europe who develop COPD are more likely to have had pneumonia as adults.
This means that it isn't just exposure to tobacco smoke and other kinds of fumes that cause COPD, it can also be lower respiratory tract infections. A bout with pneumonia can lead to higher risk of COPD. Also, data that locate the highest rate of COPD in the world in Cape Town, South Africa, 22 percent, suggest that genetic factors can also doom some people to deal with the disease.
If you have ever been the caretaker for someone who has advanced COPD, you will surely not want to go through that disease yourself. The most important thing to do to prevent the disease still is to stop smoking if you currently smoke. Smoking a pack a day for more than 10 years becomes a significant risk factor for COPD. However, even if you don't smoke:
- Get a flu shot every year. Every time you get influenza, you increase your risk for COPD.
- If you are over 50, get the vaccination for bacterial pneumonia every five years. In the US, you need a vaccination with a medication called Prevnar-13.
- Even if you do get a flu shot, be meticulous about washing your hands during flu and colds season so you do not get a virus.
- Don't spend all your time in front of a barbecue pit or a fireplace. Even well-ventilated fires release large amounts of particulate matter.
- If you work in dusty conditions or around chemical fumes, take every available precaution to minimize your exposure.
- Zhang J, Lin XF, Bai CX. Comparison of clinical features between non-smokers with COPD and smokers with COPD: a retrospective observational study. Int J Chron Obstruct Pulmon Dis. 2014. 9:57-63. doi: 10.2147/COPD.S52416. Epub 2014 Jan 8.
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