<p>Characteristics of Patients with Chronic Obstructive Pulmonary Disease Exposed to Different Environmental Risk Factors: A Large Cross-Sectional Study</p>

Abstract

Purpose: Tobacco smoking, biomass smoke, and occupational exposure are the main risk factors for chronic obstructive pulmonary disease (COPD). The present study analyzes data on exposure to these factors in a cohort of patients with COPD and assesses their differences in demographic and clinical characteristics. Patients and Methods: The cross-sectional observational study was conducted from November 2016 to December 2019. Inclusion criteria were patients aged over 40 years old with post-bronchodilator forced expiratory volume in 1 second (FEV 1)/forced vital capacity (FVC) <0.7. At baseline, demographic features and exposure history were recorded. Moreover, respiratory symptoms were assessed by the COPD Assessment Test (CAT) and modified Medical Research Council scale (mMRC). A generalized linear mixed model was used to adjust for potential confounders. Results: A total of 5183 patients with COPD were included in the final analysis. The results demonstrate that exposure to tobacco combined with other risk factors resulted in significantly higher CAT scores (16.0 ± 6.7 vs 15.3 ± 6.3, P = 0.003) and more severe dyspnea (patients with mMRC ≥ 2, 71.5% vs 61.6%, P < 0.001) than exposure to tobacco alone. In addition, COPD patients with biomass smoke exposure alone had higher CAT scores than patients with only tobacco or occupational exposure (17.5 ± 6.3 vs 15.3 ± 6.3, and 15.2 ± 6.3, respectively, P < 0.05 for each comparison) and were more likely to be female and older. In addition, COPD patients who suffered from occupational exposure developed more severe dyspnea than those exposed to tobacco alone (70.8% vs 61.6%, P < 0.05), as did those exposed to biomass smoke alone (74.2% vs 61.6%, P < 0.05). This difference remained strong even after adjustment for potential confounders. Conclusion: There are significant demographic and clinical differences among COPD patients with tobacco smoking, biomass smoke, and occupational exposures.

Adherence to Inhaled Therapy in Patients with COPD Associated to Pneumoconiosis

“…COPD patients suffered from occupational exposure developed more severe dyspnea than those exposed to tobacco alone. 6 However, non-adherence to therapy can be surprising high in our study, that in very symptomatic patients (mMRC grade ≥ 2) and less symptomatic patients (mMRC grade < 2), the future non-adherence rate was as high as 48.61% (70/144) and 75.36% (52/69), respectively. Disease heterogeneity for pneumoconiosis with COPD and subjective cognition on COPD may play a role in individual adherence behavior.…”

“…Notably, our group first reported that patients with COPD who suffered from occupational exposure developed more severe dyspnea than those exposed to tobacco alone. 6 Moreover, COPD patients exposed to occupational dust have distinct exposure pattern and different imaging and pathology features compared to those exposed to cigarette smoke. 2 , 7 , 8 The effect of dust on emphysema is small 7 but on opacity profusion and fibrosis 8 is prominent when compared to the effect of tobacco smoking.…”

The Characteristics of Airflow Limitation and Future Exacerbations in Different GOLD Groups of COPD Patients

“…Occupational exposure was defined as exposure to dust, gases, chemical substances, paints, or metals at work for at least 8 hours per day for at least 1 year. 15 …”

Real-World Effectiveness of Inhalation Therapy Among Patients With Symptomatic COPD in China: A Multicenter Prospective Study

“…With the progression of COPD, the burden of symptoms increases and quality of life declines. Symptomatic patients with COPD (group B and D) account for the vast majority in China ( Duan et al, 2020 ). Furthermore, compared with patients with well-controlled symptoms, more symptomatic patients have a higher risk of acute exacerbations and poorer disease prognosis ( Roche et al, 2013 ; Miravitlles and Ribera, 2017 ).…”