@article {Montes de Ocarespcare.05440, author = {Maria Montes de Oca and Gustavo Zabert and Dolores Moreno and Maria E Laucho-Contreras and Maria Victorina Lopez Varela and Filip Surmont}, title = {Smoke, Biomass Exposure, and COPD Risk in the Primary Care Setting: The PUMA Study}, elocation-id = {respcare.05440}, year = {2017}, doi = {10.4187/respcare.05440}, publisher = {Respiratory Care}, abstract = {BACKGROUND: The evidence indicates that risk factors other than smoking are important in the development of COPD. It has been postulated that less traditional risk factors (eg, exposure to coal and/or biomass smoke) may interact with smoking to further increase COPD risk. This analysis evaluated the effect of exposure to biomass and smoking on COPD risk in a primary care setting in Latin America.METHODS: Subjects attending routine primary care visits, >=40 y old, who were current or former smokers or were exposed to biomass smoke, completed a questionnaire and performed spirometry. COPD was defined as post-bronchodilator FEV1/FVC \< 0.70 and the lower limit of normal. Smoking was defined by pack-years (<= 20, 20-30, or \> 30), and biomass exposure was defined as an exposure to coal or wood (for heating, cooking, or both) for >= 10 y.RESULTS: One thousand seven hundred forty-three individuals completed the questionnaire, and 1,540 performed spirometry. Irrespective of COPD definition, approximately 40\% of COPD subjects reported exposure to biomass versus 30\% of those without COPD. A higher proportion of COPD subjects (post-bronchodilator FEV1/FVC \< 0.70) than those without COPD smoked \> 30 pack-years (66\% vs 39\%); similar results were found with the lower limit of normal definition. Analysis of exposure to biomass \> 10 y plus smoking \> 20 pack-years (reference was no exposure) found that tobacco smoking (crude odds ratio [OR] 4.50, 95\% CI 2.73-7.41; adjusted OR 3.30, 95\% CI 1.93-5.63) and biomass exposure (crude OR 3.66, 95\% CI 2.00-6.73; adjusted OR 2.28, 95\% CI 1.18-4.41) were risk factors for COPD, with smoking a possible confounder for the association between biomass and COPD (post-bronchodilator FEV1/FVC \< 0.70); similar results were found with the lower limit of normal definition.CONCLUSIONS: Subjects with COPD from primary care had a higher exposure to biomass and smoking compared with non-COPD subjects. Smoking and biomass are both risk factors for COPD, but they do not appear to have an additive effect.}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/early/2017/05/30/respcare.05440}, eprint = {https://rc.rcjournal.com/content/early/2017/05/30/respcare.05440.full.pdf}, journal = {Respiratory Care} }