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BACKGROUND: Chronic obstructive pulmonary disease (COPD) in never-smokers may have other clinical characteristics than tobacco smoking-related COPD.

RESEARCH QUESTION: What are the risk factors, biomarkers, respiratory symptoms and health status in never-smoking individuals with COPD?

STUDY DESIGN AND METHODS: We investigated never-smokers with COPD (n=154, mean age 60 years) from the population-based Swedish CArdioPulmonary bioImage Study (SCAPIS), and compared them with four control groups: never-smokers with normal lung function (n=281), current smokers with normal lung function (n=97), ex-smokers with COPD (n=103) and current smokers with COPD (n=55). COPD was defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) less than the lower limit of normal (LNN) after bronchodilation. We examined fractional exhaled nitric oxide (FeNO), blood biomarkers, respiratory symptoms, health status, medical history and living conditions.

RESULTS: The never-smoker COPD group reported more respiratory symptoms and worse health status than never-smokers with normal lung function, but fewer symptoms, milder airflow limitation and better health status compared with ex-smokers and smokers with COPD. Never-smokers with COPD had more self-reported asthma. Moreover, never-smokers with COPD had higher Immunoglobulin E sensitisations to a mix of aeroallergens, higher geometrical mean FeNO levels and blood eosinophil counts than never-smokers with normal lung function. When participants with self-reported asthma were excluded, never-smokers with COPD still had more wheeze, cough and higher FeNO.

CONCLUSION: Never-smokers with COPD had more respiratory symptoms and elevated markers of type-2 inflammation, suggesting they might represent a distinct clinical phenotype which may differ from smoking-related COPD. They may therefore need to be treated and followed differently.

TRIAL REGISTRATION NUMBER: NCT03049202.