Risk factors for severe exacerbation for chronic obstructive pulmonary disease (COPD) in never-smokers: study in primary care

Background The proportion of patients with Chronic Obstructive Pulmonary Disease who have never smoked (COPD-NS) is very high. However, the clinical-epidemiological characteristics of these patients and their association with severe exacerbation have been poorly studied. Objective To determine the clinical-epidemiological characteristics of COPD-NS and determine if the incidence of severe exacerbation is higher compared to COPD smokers/ex-smokers, comparing the characteristics of both cohorts and the risk factors. Patients and Methods: A cohort study that analyzed severe exacerbation and associated factors in 490 COPD-NS patients monitoring 2 years. Severe exacerbation defined as events required hospitalization. Variables of interest were recorded for each patient, and we analyzed their association with severe exacerbation through the adjusted odds ratio (aOR) by means of a logistic regression model. Results The prevalence of COPD-NS was 40.66% of a total of 2,376 patients with COPD. During the 2 years of monitoring, 165 patients suffered at least a severe exacerbation (48.48% were COPD-NS). The risk factors also strongly associated with severe exacerbation were being atrial fibrillation (aOR: 2.41) and bronchiectasis (aOR: 2.06). COPD smokers/ex-smokers and COPD-NS share common risk factors but with a different impact. Conclusions The prevalence of COPD-NS patients is high, and although the incidence of severe exacerbation is the same as in the rest of COPD, the clinical characteristics of this subgroup are different, as are the risk factors for severe exacerbation.