Acute exacerbations of chronic obstructive pulmonary disease in a cohort of Chinese never smokers goes along with decreased risks of recurrent acute exacerbation, emphysema and comorbidity of lung cancer as well as decreased levels of circulating eosinophils and basophils

Abstract

Acute exacerbations show a significant impact on disease morbidity and mortality in chronic obstructive pulmonary disease (COPD). In contrast to stable COPD, the association of smoking status with clinical and laboratory characteristics in patients with acute exacerbations of COPD (AECOPD) has not been well studied. In this retrospective study, we compared never smokers and ever smokers on their demographic, clinical, and laboratory characteristics in a Chinese clinical cohort of AECOPD. In this cohort comprising 1,034 consecutive patients with AECOPD, never smokers were older (75 vs 70.5 years, padjusted < 0.001) and had a higher body mass index than smokers (21.1 ± 4.0 vs 20.3 ± 3.4, padjusted = 0.028). Furthermore, never smokers showed a decreased risk of recurrent acute exacerbation (13.0 vs 21.8%, padjusted = 0.029), a lower risk of development of emphysema (77.8 vs 89.1%, padjusted < 0.001), a lower prevalence of the co-morbidity of lung cancer (0.5 vs 6.6%, padjusted < 0.001), lower levels of circulating eosinophils (EO; 0.04 × 109/L vs 0.10 × 109/L, padjusted = 0.007) and basophils (BA; 0.02 × 109/L vs 0.03 × 109/L, padjusted = 0.019), and a higher plasma levels of D-dimer (0.62 μg/ml vs 0.51 μg/ml, padjusted = 0.02). Furthermore, multivariate logistic regression analysis identified several risk factor for the recurrent acute exacerbation, such as smoking [odds ratio (OR) = 1.84, 95% CI: 1.03–3.40, p = 0.044], urban residential area (OR = 1.43, 95% CI: 1.01–2.05, p = 0.045), and the presence of emphysema (OR = 2.31, 95% CI: 1.25–4.69, p = 0.012). In conclusion, this study demonstrates that the smoking status of patients is associated with recurrent acute exacerbations, emphysema, lung cancer, and levels of circulating EO and BA in AECOPD. Identification of cigarette smoking as a risk factor for recurrent acute exacerbation supports behavioral intervention of smoking cessation in the management of patients with AECOPD.

Cigarette Smoke-Induced Respiratory Response: Insights into Cellular Processes and Biomarkers

“…Bacterial infections are commonly associated with AE-COPD [ 341 , 342 , 343 , 344 ] and COPD patients due to their compromised airways. Wang et al categorized AE-COPD patients as smokers or non-smokers and conducted an analysis of the hematological parameters, which demonstrated that smokers exhibited higher counts of eosinophils and basophils in BAL [ 345 ]. Moreover, Li and colleagues reported that, as compared to smokers, non-smokers with AE-COPD had higher FEV1/forced vital capacity (FVC) and experienced less wheezing and phlegm production [ 346 ].…”

Serum YKL-40 Levels in Patients with Asthma or COPD: A Pilot Study

“…COPD is one of the top five leading causes of mortality during the 21st century, especially within the oldest age group. For example, it was the third global cause of death in 2019, with approximately 3.23 million deaths [ 2 ]. In contrast, respiratory mortalities associated with BA are seven-fold lower than those reported for COPD [ 3 ].…”

“…Characterized by bronchial hyper-reactivity and airway obstruction, this disease generally starts in childhood, although its adult onset is not uncommon [ 6 ]. COPD, by contrast, occurs primarily in middle-aged or older adults, with smoking being linked to nine out of ten cases [ 2 ]. This common and preventable chronic respiratory condition affects lung parenchyma and peripheral airways.…”

The Lung Microbiome in COPD and Lung Cancer: Exploring the Potential of Metal-Based Drugs

“…There is a high incidence of lung cancer 2 of 32 among people with COPD, and this association transcends the established connection that both conditions have with a smoking history. For instance, several studies have reported a heightened risk of lung cancer in people with COPD, independent of age or tobacco use [16][17][18][19][20][21][22][23]. The data suggest that COPD in those who smoke have a two to five-fold higher risk of developing lung cancer compared to non-smokers, with the overall survival rate in those with COPD and lung cancer significantly lower than those with lung cancer without COPD [17,24,25].…”