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Published ahead of print on July 25, 2002, doi:10.1164/rccm.200203-245OC

Am. J. Respir. Crit. Care Med., Volume 166, Number 8, October 2002, 1078-1083

A more recent version of this article appeared on October 15, 2002
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Submitted on March 25, 2002
Accepted on July 18, 2002

Clinical, radiological and induced sputum features of COPD in Non Smokers. A descriptive study

Surinder S Birring1*, Christopher E Brightling1, Peter Bradding1, James J Entwisle2, Dhiraj D Vara3, Jonathon Grigg4, Andrew J Wardlaw1, and Ian D Pavord1

1 Respiratory Medicine, Glenfield Hospital, Institute for Lung Health, Leicester, United Kingdom, 2 Radiology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom, 3 Respiratory Physiology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom, 4 Leicester Childrens Asthma Centre, Institute For Lung Health, Leicester, United Kingdom

* To whom correspondence should be addressed. E-mail: sb134{at}le.ac.uk.

Epidemiological studies show that 5-12% of subjects with COPD are non-smokers. Little is known about the pathophysiology of the fixed airflow obstruction in these subjects. We have prospectively identified 25 patients with COPD who never smoked or had a <5 pack years smoking history. Our population represented 5.7% of total referrals with fixed airflow obstruction over 2 years. Patients had a mean age of 70 years, were predominantly female (86%), with a mean duration of respiratory symptoms of 7 years. The mean FEV1% predicted was 58%, and FEV1 /FVC 55%. Features on HRCT were non-specific and considered typical of a wider population with COPD. Induced sputum differential inflammatory cell count suggested the presence of 2 distinct groups. 9 had significant sputum eosinophilia (mean 8.1%: normal <1.9%) and the remaining 13 had a normal sputum eosinophil and tended to have a raised sputum neutrophil count (mean 70.1%: normal <65%). Organ specific autoimmune disease was present in 7 of the 22 patients (32%) and was particularly prevalent in those without sputum eosinophilia (6 of 13). In conclusion, COPD in non-smokers predominantly affect females and has at least 2 pathological subgroups, one of which may be associated with organ specific autoimmune disease. Further investigation of this group may disclose novel mechanisms of fixed airflow obstruction.




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