COPD and Smoking Status - It Does Matter: Characteristics and Prognosis of COPD According to Smoking Status

Anne O Nielsen, Peter Lange, Ole Hilberg, Ingeborg Farver-Vestergaard, Rikke Ibsen, Anders Løkke

Research output: Contribution to journalJournal articleResearchpeer-review


BACKGROUND: Chronic Obstructive Pulmonary Disease is a chronic, often progressive disease, which in most patients is caused by tobacco smoking. Our study focuses on differences in COPD-related outcomes between never-smokers, former smokers and current smokers.

METHODS: A nationwide, population-based cohort study utilizing Danish health registries. Clinical and socioeconomical variables including smoking status, comorbidities, and dyspnoea were obtained. Poisson and Cox Regression were used to calculate the impact of these clinical parameters on risk of moderate and severe exacerbations and mortality during 12 months of follow-up.

RESULTS: 49.826 patients ≥40 years of age, with a hospital diagnosis of COPD in 2008-2017, were identified (mean age 69.2 years, 52% females). 2,127 (4%) were never-smokers, 29,854 (60%) former smokers and 17,845 (36%) current smokers. Compared to former and current smokers, never-smokers reported a lower MRC score and had a milder COPD stage according to GOLD classification. During follow-up, never-smokers had a significant lower risk of severe exacerbations (HR 0.87, 95% CI 0.78-0.97) and a lower rate of death (mortality ratio 0.75, 95% CI 0.70-0.81) compared to patients with a smoking history.

DISCUSSION: Our nationwide study showed that COPD in never-smokers is characterized by a lower level of dyspnoea, milder lung function impairment and a lower risk of exacerbations and death. At the same time, we found active smokers to have the highest risk. These findings highlight the need for campaigns to prevent smoking and may help general practitioners as well as other health care professionals to motivate patients with COPD to stop smoking.

Original languageEnglish
JournalJournal of the COPD Foundation
Issue number1
Pages (from-to)56-67
Publication statusPublished - 25. Jan 2024

Bibliographical note

JCOPDF © 2023.


  • COPD
  • exacerbations
  • never smokers
  • prognosis
  • smoking


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