, Volume 194, Issue 3, pp 353–361 | Cite as

The Risk Factors and Characteristics of COPD Among Nonsmokers in Korea: An Analysis of KNHANES IV and V

  • Su Hwan Lee
  • Eu Dong Hwang
  • Ju Eun Lim
  • Sungwoo Moon
  • Young Ae Kang
  • Ji Ye Jung
  • Moo Suk Park
  • Se Kyu Kim
  • Joon Chang
  • Young Sam Kim
  • Song Yee KimEmail author



Chronic obstructive pulmonary disease (COPD) is increasing in prevalence and mortality. This study evaluated the prevalence, risk factors, characteristics, and health-related quality of life (HRQoL) of COPD among nonsmokers in Korea.


This was a population-based cross-sectional study using data obtained from the Fourth and Fifth Korean National Health and Nutrition Examination Survey, which was conducted from 2007 to 2011.


A total of 15,063 participants completely answered the questionnaire and performed the spirometry. Among them, 59.6 % were nonsmokers and 40.4 % were smokers. The prevalence of nonsmoker COPD was 7.1 %. On multivariate analysis, age ≥65 years (OR, 2.93; 95 % CI, 2.44–3.51), male sex (OR, 2.98; 95 % CI, 2.40–3.71), living in rural area (OR, 1.26; 95 % CI, 1.05–1.51), lower body mass index (BMI) (<18.5 kg/m2) (OR, 3.00; 95 % CI, 1.78–5.01), self-reported asthma (OR, 2.72; 95 % CI, 2.05–3.60), and self-reported tuberculosis (OR, 4.73; 95 % CI, 3.63–6.17) showed a significantly higher risk of nonsmoker COPD. Analysis of nonsmoker and smoker COPD revealed that there are more females in nonsmoker COPD patients (73.9 vs. 6.9 %, P < 0.001). Nonsmoker COPD patients presented with impaired mobility, pain/discomfort, and anxiety/depression functions as well as a lower mean EuroQol Five-Dimension Questionnaire utility score, which showed HRQoL.


The burden of nonsmoker COPD was considerable. Older age, male sex, lower BMI, self-reported asthma, and self-reported tuberculosis were risk factors for nonsmoker COPD and there were differences between nonsmoker and smoker COPD in terms of sex, comorbidities, and HRQoL.


Chronic obstructive pulmonary disease Nonsmoker Never-smoker Quality of life Population study 


Compliance with Ethical Standards

Conflict of Interest


Supplementary material

408_2016_9871_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 kb)


  1. 1.
    Vestbo J, Hurd SS, Agusti AG et al (2013) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 187(4):347–365CrossRefPubMedGoogle Scholar
  2. 2.
    Cavailles A, Brinchault-Rabin G, Dixmier A et al (2013) Comorbidities of COPD. Eur Respir Rev 22(130):454–475CrossRefPubMedGoogle Scholar
  3. 3.
    McGarvey LP, John M, Anderson JA et al (2007) Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee. Thorax 62(5):411–415CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Garrido PC, de MiguelDiez J, RejasGutierrez J et al (2006) Negative impact of chronic obstructive pulmonary disease on the health-related quality of life of patients Results of the EPIDEPOC study. Health Qual Life Outcomes 4:31CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Rutten-van Molken MP, Oostenbrink JB, Tashkin DP et al (2006) Does quality of life of COPD patients as measured by the generic EuroQol five-dimension questionnaire differentiate between COPD severity stages? Chest 130(4):1117–1128CrossRefPubMedGoogle Scholar
  6. 6.
    Ferrer M, Alonso J, Morera J et al (1997) Chronic obstructive pulmonary disease stage and health-related quality of life. The Quality of Life of Chronic Obstructive Pulmonary Disease Study Group. Ann Intern Med 127(12):1072–1079CrossRefPubMedGoogle Scholar
  7. 7.
    DiBonaventura M, Paulose-Ram R, Su J et al (2012) The impact of COPD on quality of life, productivity loss, and resource use among the elderly United States workforce. Copd 9(1):46–57CrossRefPubMedGoogle Scholar
  8. 8.
    Murray CJ, Lopez AD (1997) Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet 349(9064):1498–1504CrossRefPubMedGoogle Scholar
  9. 9.
    Cosio MG, Saetta M, Agusti A (2009) Immunologic aspects of chronic obstructive pulmonary disease. N Engl J Med 360(23):2445–2454CrossRefPubMedGoogle Scholar
  10. 10.
    Perez-Padilla R, Fernandez R, Lopez Varela MV et al (2012) Airflow obstruction in never smokers in five Latin American cities: the PLATINO study. Arch Med Res 43(2):159–165CrossRefPubMedGoogle Scholar
  11. 11.
    Hagstad S, Ekerljung L, Lindberg A et al (2012) COPD among non-smokers: report from the obstructive lung disease in Northern Sweden (OLIN) studies. Respir Med 106(7):980–988CrossRefPubMedGoogle Scholar
  12. 12.
    Zhou Y, Wang C, Yao W et al (2009) COPD in Chinese nonsmokers. Eur Respir J 33(3):509–518CrossRefPubMedGoogle Scholar
  13. 13.
    Lamprecht B, McBurnie MA, Vollmer WM et al (2011) COPD in never smokers: results from the population-based burden of obstructive lung disease study. Chest 139(4):752–763CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Waked M, Salame J, Khayat G et al (2012) Correlates of COPD and chronic bronchitis in nonsmokers: data from a cross-sectional study. Int J Chron Obstruct Pulmon Dis 7:577–585CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Bridevaux PO, Probst-Hensch NM, Schindler C et al (2010) Prevalence of airflow obstruction in smokers and never smokers in Switzerland. Eur Respir J 36(6):1259–1269CrossRefPubMedGoogle Scholar
  16. 16.
    Miller MR, Hankinson J, Brusasco V et al (2005) Standardisation of spirometry. Eur Respir J 26(2):319–338CrossRefPubMedGoogle Scholar
  17. 17.
    Choi JK, Paek D, Lee JO (2005) Normal predictive values of spirometry for Korean population. Tuberc Respir Dis 58(3):230–242CrossRefGoogle Scholar
  18. 18.
    Group TE (1990) EuroQol–a new facility for the measurement of health-related quality of life. Health Policy 16(3):199–208CrossRefGoogle Scholar
  19. 19.
    Rabin R, de Charro F (2001) EQ-5D: a measure of health status from the EuroQol Group. Ann Med 33(5):337–343CrossRefPubMedGoogle Scholar
  20. 20.
    Lee YK, Nam HS, Chuang LH et al (2009) South Korean time trade-off values for EQ-5D health states: modeling with observed values for 101 health states. Value Health 12(8):1187–1193CrossRefPubMedGoogle Scholar
  21. 21.
    Lamprecht B, Schirnhofer L, Kaiser B et al (2008) Non-reversible airway obstruction in never smokers: results from the Austrian BOLD study. Respir Med 102(12):1833–1838CrossRefPubMedGoogle Scholar
  22. 22.
    Behrendt CE (2005) Mild and moderate-to-severe COPD in nonsmokers: distinct demographic profiles. Chest 128(3):1239–1244CrossRefPubMedGoogle Scholar
  23. 23.
    Cerveri I, Accordini S, Verlato G et al (2001) Variations in the prevalence across countries of chronic bronchitis and smoking habits in young adults. Eur Respir J 18(1):85–92CrossRefPubMedGoogle Scholar
  24. 24.
    Kim DS, Kim YS, Jung KS et al (2005) Prevalence of chronic obstructive pulmonary disease in Korea: a population-based spirometry survey. Am J Respir Crit Care Med 172(7):842–847CrossRefPubMedGoogle Scholar
  25. 25.
    Caballero A, Torres-Duque CA, Jaramillo C et al (2008) Prevalence of COPD in five Colombian cities situated at low, medium, and high altitude (PREPOCOL study). Chest 133(2):343–349CrossRefPubMedGoogle Scholar
  26. 26.
    Kanervisto M, Vasankari T, Laitinen T et al (2011) Low socioeconomic status is associated with chronic obstructive airway diseases. Respir Med 105(8):1140–1146CrossRefPubMedGoogle Scholar
  27. 27.
    Harik-Khan RI, Fleg JL, Wise RA (2002) Body mass index and the risk of COPD. Chest 121(2):370–376CrossRefPubMedGoogle Scholar
  28. 28.
    Buist AS, McBurnie MA, Vollmer WM et al (2007) International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet 370(9589):741–750CrossRefPubMedGoogle Scholar
  29. 29.
    Miravitlles M, Ferrer M, Pont A et al (2005) Characteristics of a population of COPD patients identified from a population-based study. Focus on previous diagnosis and never smokers. Respir Med 99(8):985–995CrossRefPubMedGoogle Scholar
  30. 30.
    Eisner MD (2007) Indoor air, passive smoking, and COPD. Am J Respir Crit Care Med 176(5):426–427CrossRefPubMedGoogle Scholar
  31. 31.
    Salvi SS, Barnes PJ (2009) Chronic obstructive pulmonary disease in non-smokers. Lancet 374(9691):733–743CrossRefPubMedGoogle Scholar
  32. 32.
    Nizankowska-Mogilnicka E, Mejza F, Buist AS et al (2007) Prevalence of COPD and tobacco smoking in Malopolska region–results from the BOLD study in Poland. Pol Arch Med Wewn 117(9):402–410PubMedGoogle Scholar
  33. 33.
    Pasipanodya JG, Miller TL, Vecino M et al (2007) Pulmonary impairment after tuberculosis. Chest 131(6):1817–1824CrossRefPubMedGoogle Scholar
  34. 34.
    Hnizdo E, Singh T, Churchyard G (2000) Chronic pulmonary function impairment caused by initial and recurrent pulmonary tuberculosis following treatment. Thorax 55(1):32–38CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Elkington PT, Friedland JS (2006) Matrix metalloproteinases in destructive pulmonary pathology. Thorax 61(3):259–266CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Kim SH, Oh YM, Jo MW (2014) Health-related quality of life in chronic obstructive pulmonary disease patients in Korea. Health Qual Life Outcomes 12:57CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Hong JY, Kim SY, Chung KS et al (2015) Factors associated with the quality of life of Korean COPD patients as measured by the EQ-5D. Qual Life Res 24(10):2549–2558CrossRefPubMedGoogle Scholar
  38. 38.
    Roberts SD, Farber MO, Ks Knox et al (2006) FEV1/FVC ratio of 70 % misclassifies patients with obstruction at the extremes of age. Chest 130(1):200–206CrossRefPubMedGoogle Scholar
  39. 39.
    Hwang YI, Kim CH, Kang HR et al (2009) Comparison of the prevalence of chronic obstructive pulmonary disease diagnosed by lower limit of normal and fixed ratio criteria. J Korean Med Sci 24(4):621–626CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Wang Y, Xiao W, Ma DD et al (2013) Predicted lower limit of normal reduces misclassification risk of airflow limitation in asymptomatic elderly never-smokers. Chin Med J 126(18):3486–3492PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Su Hwan Lee
    • 1
  • Eu Dong Hwang
    • 1
  • Ju Eun Lim
    • 1
  • Sungwoo Moon
    • 1
  • Young Ae Kang
    • 1
  • Ji Ye Jung
    • 1
  • Moo Suk Park
    • 1
  • Se Kyu Kim
    • 1
  • Joon Chang
    • 1
  • Young Sam Kim
    • 1
  • Song Yee Kim
    • 1
    Email author
  1. 1.Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest DiseasesYonsei University College of MedicineSeoulKorea

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