Original Research Article DOI: 10.18231/2581-4222.2019.0013 IP Indian Journal of Immunology and Respiratory Medicine, January-March, 2019;4(1):60-64 60 A clinical study of chronic obstructive pulmonary disease in non-smokers attending a tertiary care hospital P V Kalyan Kumar 1 , G. Ramakrishna 2,* 1,2 Associate Professor, 1 Dept. of Respiratory Medicine, 2 Dept. of General Medicine, Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India *Corresponding Author: G. Ramakrishna Email: drpvkalyan@hotmail.com Abstract Background: Chronic Obstructive Pulmonary Disease (COPD) ranks third among the prime causes of death globally. 1. To study the clinical profile of COPD in non-smokers. 2. To identify the other risk factors (other than smoking) of COPD. Methodology: Data was collected meeting the objectives of the study with a pre-tested proforma. Detailed history was taken, clinical examination was done and necessary investigations were carried out. Continuous data was expressed as Mean + SD and categorical data was expressed as number and percentage (%). Results: In the present study it was observed that most of the non-smoker COPD patients belonged to older age group. In the present study the mean age of the patients was 55.06 + 8.87 years. study subjects < 40 years were 6%, 40-59 years were 64%, 60-79 years were 30% and >80 years were 0% females account for 68%, with a male to female ratio of 1: 2.125. Conclusions: In this study of COPD in non-smokers, females were predominant. Cough and sputum production were the most common clinical features. Environmental tobacco smoke exposure and biomass fuel usage were the most common risk factors. Most of the patients belonged to rural background. Most of the patients presented with less severe form of the disease. Keywords: COPD; Non-smoker; Cough; Biomass; Smoking. Introduction Chronic Obstructive Pulmonary Disease (COPD) ranks third among the prime causes of death globally [1]. It occupies fifth position in Southern Asia [2]. As per the Global Burden of Disease Study 2013, more than 300 million people in the world are suffering from COPD [3]. The nature of device used for cooking also has a significant impact on indoor air pollution. In India, four types of cooking devices are commonly used. These are (1) kerosene stove (wick type or pressure type); (2) coal-lighted “angithi;” (3) gas stove operated by liquefied petroleum gas (LPG); and (4) “chulla” in which biomass fuels (dried dung, crop residues, and agricultural wastes) are used [4]. It is well recognized that all kinds of cooking fuels generate respiratory irritants like unburnt hydrocarbons (soot), sulphur dioxide and the oxides of nitrogen. Soot particles that are produced from chulla used for fire wood cooking perhaps are more perilous in causing chronic bronchitis changes and airway obstruction as well. According to various investigators from our country chronic bronchitis among non- smoking women was found to vary between 0.44 - 4.96 percent [5]. The effect of domestic cooking fuels on causing various respiratory symptoms had been studied in about 3,701 women. Of these, 3,608 were non- smoking women who used either of the four different cooking fuels: kerosene, LPG, biomass and mixed fuels. The respiratory symptoms were noted in 13 percent. Mixed fuel users suffered from more respiratory symptoms than others (16.7%), next comes biomass users (12.6%), stove users (11.4%). Occupational Exposure: There is increasing evidence from large population centered studies indicating that a unstinting proportion of the COPD cases in a society may be ascribed to exposure to dusts, fumes, noxious gases/ vapours. The industries such as fabric manufacturing, leather manufacturing, plastics, rubber and construction are associated with augmented risk. The overall risk among never smokers it was 31 percent. Environmental tobacco exposure or passive smoking is drawing more attention owing to its considerable effects on public health. Environmental tobacco smoke is a blend of side-stream smoke and exhaled main-stream smoke. The side stream smoke has higher concentrations of benzene, ammonia, nicotine, carbon- monoxide, and various carcinogens (2-naphthylamine, 4-aminobiphenyl, n- nitrosamine, benza-anthracene, and benzopyrene) owing to a lower combustion temperature, than that of mainstream smoke [8]. Depending on biochemical markers, such as urinary and salivary levels of cotinine and nicotine, the degree of exposure has been estimated to be equivalent to 0.1–2 cigarettes per a day. Exposure to ETS is virtually unavoidable because it is ubiquitous in workplaces, homes and crowded areas. Environmental smoke typically troubles females to a much greater degree than males. It conveys ancillary evidence of the grave health hazards linked to environmental smoke. At home females were more commonly exposed to ETS (31% versus 19%), whereas males were more exposed outside (53% versus 7%). The females (37.7%) suffered from more symptoms due to ETS than males (21.6%). These