Clinical characteristics of tobacco smoke-induced versus biomass fuel-induced chronic obstructive pulmonary disease

OBJECTIVE: To investigate differences in clinical features between tobacco smoke-induced and biomass fuel-induced chronic obstructive pulmonary disease (COPD). METHODS: We retrospectively analyzed 206 patients with COPD caused by exposure to tobacco smoke and 81 cases of COPD caused by exposure to biomass fuels who received treatment in our hospital between 2011 March and 2014 March. Difference in general health status, clinical symptoms, the dyspnea score, and comorbidities between the two groups were compared. In addition, pulmonary function, grading, and acute exacerbations were also compared. RESULTS: (1) Difference in general health status: Male and female patients with COPD caused by exposure to tobacco smoke were 83.5 and 16.5%, respectively. Male and female patients with COPD caused by exposure to smoke from biomass fuels were 14.8 and 85.2% (χ(2) = 27.2, P < 0.05), respectively. Tobacco smoke-induced COPD was more prevalent in men, and COPD caused by exposure to smoke from biomass fuels was more prevalent in women. After gender adjustment, body mass index (BMI) was lower in women with COPD caused by exposure to smoke from biomass fuels than those by tobacco smoke. There was no statistically significant difference in other indicators, such as age. (2): Difference in clinical symptoms: No statistically significant difference in the modified British Medical Research Counsel (mMRC) Questionnaire, a measure of breathlessness, was observed between the two groups. Dyspnea was more common in COPD patients that was caused by exposure to biomass fuels (38.3%) than by tobacco smoke (11.1%) (χ(2) = 17.9, P < 0.05). The comorbidities of allergic diseases (such as allergic rhinitis, bronchial asthma) were more prevalent in COPD patients that was caused by exposure to smoke from biomass fuels (43.2%) than by tobacco smoke (18%) (χ(2) = 16.1, P < 0.05). However, COPD comorbid with lung cancer was more prevalent in those cases that were caused by exposure to tobacco smoke (7.77%) than in cases caused by exposure to smoke from biomass fuels (3.7%) (χ(2) = 9.7, P < 0.05). (3) Differences in grading of pulmonary function: After gender adjustment, patients with COPD caused by exposure to biomass fuels were mostly in grade B or D. (4) Exacerbations: No significant difference in exacerbations per year was noted between the two groups. CONCLUSIONS: Marked differences exist between patients with COPD caused by exposure to tobacco smoke and smoke from biomass fuels. Patients with COPD caused by exposure to biofuels are mostly females with lower BMI and often with many clinical symptoms and complications, such as allergic rhinitis and bronchial asthma. Such patients are often in stage B or D. Tobacco smoke-induced COPD is more prevalent in male patients, often with complications in the form of lung cancer.