Chronic obstructive pulmonary disease in non-smokers

Lancet. 2009 Aug 29;374(9691):733-43. doi: 10.1016/S0140-6736(09)61303-9.


Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Tobacco smoking is established as a major risk factor, but emerging evidence suggests that other risk factors are important, especially in developing countries. An estimated 25-45% of patients with COPD have never smoked; the burden of non-smoking COPD is therefore much higher than previously believed. About 3 billion people, half the worldwide population, are exposed to smoke from biomass fuel compared with 1.01 billion people who smoke tobacco, which suggests that exposure to biomass smoke might be the biggest risk factor for COPD globally. We review the evidence for the association of COPD with biomass fuel, occupational exposure to dusts and gases, history of pulmonary tuberculosis, chronic asthma, respiratory-tract infections during childhood, outdoor air pollution, and poor socioeconomic status.

Publication types

  • Review

MeSH terms

  • Air Pollution / adverse effects
  • Asthma / complications
  • Cause of Death
  • Developing Countries
  • Female
  • Fossil Fuels / adverse effects
  • Global Health*
  • Humans
  • Male
  • Morbidity
  • Nutrition Disorders / complications
  • Occupational Exposure / adverse effects
  • Prevalence
  • Pulmonary Disease, Chronic Obstructive / epidemiology*
  • Pulmonary Disease, Chronic Obstructive / etiology*
  • Respiratory Tract Infections / complications
  • Risk Assessment
  • Risk Factors
  • Smoking / epidemiology
  • Socioeconomic Factors
  • Tuberculosis, Pulmonary / complications


  • Fossil Fuels