Elsevier

Respiratory Medicine

Volume 100, Issue 6, June 2006, Pages 1110-1116
Respiratory Medicine

Racial and gender differences in susceptibility to tobacco smoke among patients with chronic obstructive pulmonary disease

https://doi.org/10.1016/j.rmed.2005.09.019Get rights and content
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Summary

Background

Although chronic obstructive pulmonary disease (COPD) has been considered a disease of Caucasian men, recent data show mortality rising faster among women and African-Americans. Some have suggested these groups are more susceptible to tobacco smoke. We examined this issue in our own population of COPD patients.

Methods

Beginning in March 2003 we prospectively developed a COPD research database to facilitate recruitment for clinical trials. Enrollees are recruited from clinics and paid advertising and their demographics, medical/smoking histories, and spirometric data are recorded. We examined the smoking histories and pulmonary function of enrollees over 45, with ⩾20 pack-years of smoking, FEV1/FVC (forced expiratory volume forced vital capacity) <0.70, and a race-adjusted post-bronchodilator FEV1<80%. The primary outcome was the loss of lung function per pack-year smoked, or Susceptibility Index (SI), calculated using the formula: (% predicted FEV1−100)/pack-years.

Results

A total of 585 patients enrolled during the study period and 330 met our inclusion criteria. Caucasians were older than African-Americans (63 vs. 58, P=0.0003) and had more pack-years of smoking (57 vs. 43, P=0.0003). There were no differences in lung function or bronchodilator reversibility among the racial or gender subgroups. Caucasians had less loss of lung function per pack-year smoked than African-Americans (SI=-1.02% vs. −1.34%, P=0.007) and men less than women (SI=-0.98% vs. −1.21%, P=0.001). Caucasian males appeared relatively protected from tobacco smoke (SI=-0.93%), while African-American women appeared most susceptible (SI=-1.42%).

Conclusions

There are important differences in racial and gender susceptibility to tobacco smoke among patients with COPD. African-American females appear to be at highest risk and may benefit most from smoking cessation.

Keywords

Chronic obstructive pulmonary disease
Smoking
Race

Abbreviations

COPD
Chronic obstructive pulmonary disease
FEV1
Forced expiratory volume
FVC
Forced vital capacity
SI
Susceptibility Index
WHO
World Health Organization
GOLD
Global Initiative for Chronic Obstructive Lung Disease
TNF
Tumor necrosis factor
IL
Interleukin
Ig
Immunoglobulin

Cited by (0)

The authors have no financial interests to declare.