Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Tobacco smoking is established as a major risk factor. However, especially in the last 20 years, there are studies have shown that long-term exposure to biomass fuel smoke to cook and heat homes, also carries a high risk for the development of COPD. This occurs particularly in developing countries and it´s estimated that 25-45% of patients with COPD have never smoked and the burden of COPD not associated with smoking is possibly higher than previously believed. Although exposure to biomass is the major risk factor for COPD not associated with smoking, there are other associated factors such as occupational exposure to dust and gases, HIV/AIDS, lower respiratory tract infection (particularly in the childhood), chronic asthma, external pollution, poverty, and history of pulmonary tuberculosis (PTB). PTB affects more than 9 million people and kills 1.5 million people each year. Prevalence of airflow obstruction varies from 28% to 68% of patients with PTB and the association occurs mainly with the COPD phenotype. Such infection is associated with airway fibrosis, and the immune response to mycobacteria can result in airway inflammation, which is characteristic of COPD. The degree of airflow obstruction is correlated with the extent of the disease. This review exposes the evidence of this association (TOPD), and some clinical, functional, anatomopathological and therapeutic aspects and particularly the need for preventive interventions to face this other side of the entity (COPD not associated with smoking) that seems to be increasing.

"El asma bronquial y la enfermedad pulmonar obstructiva crónica son dos problemas mayores de salud: su incidencia se encuentra en aumento y representan, indiscutiblemente, una causa importante de morbilidad y mortalidad a nivel mundial. Los glucocorticoides se han posicionadocomo la droga de elección en el tratamiento de padecimientos inmunológicos e inflamatorios crónicos, como el asma bronquial y la enfermedad obstructiva crónica. Estas drogas suprimen la inflamación en múltiples vías moleculares, característica que les confiere destacada eficacia."

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