Non-Tobacco and Non-Biomass Causes of COPD

Infectious Causes

Tuberculosis infection is independently associated with COPD development through triggering airway inflammatory responses that decrease lung volume 1
The inflammatory response of TB creates increased oxidative stress in airways and lung parenchyma, which are vital pathological processes in COPD development and progression 3
TB is particularly significant in developing countries where TB prevalence remains high, representing considerable public health importance 1

Asthma is strongly associated with COPD development, with a 12-fold higher risk compared to those without asthma 5, 3
Poorly controlled asthma can result in airflow obstruction meeting spirometric criteria for COPD, according to the American Thoracic Society 1, 5
Patients with asthma-COPD overlap have increased frequency of exacerbations and hospitalizations 5

Organic and inorganic dusts, chemical agents, and fumes are established COPD risk factors, as stated by the American College of Chest Physicians 4
Outdoor air pollution from industrialization and fossil fuel-driven machinery contributes to COPD, as reported by the European Respiratory Society 1
Indoor air pollution beyond biomass is a risk factor, according to the American Thoracic Society 4

Alpha-1 antitrypsin deficiency and other rare genetic syndromes cause COPD, as stated by the American College of Chest Physicians 2
Processes during gestation, birth, and childhood exposures affect lung growth and increase COPD risk, as reported by the American Thoracic Society 6, 2
Approximately 50% of COPD patients develop disease due to abnormal lung growth and development rather than accelerated decline, according to the European Respiratory Society 6

Never-smokers with COPD have distinct clinical features, including fewer symptoms, milder disease, lower systemic inflammation burden, and less emphysema, as stated by the American College of Chest Physicians 6, 2
The causes of poorly reversible airflow obstruction in low- and middle-income countries are diverse, and not everyone meeting spirometric criteria for COPD has exposure-driven airway disease, as reported by the American Thoracic Society 1, 5