Cioboata Ramona, Balteanu Mara Amalia, Mitroi Denisa Maria, Vrabie Sidonia Catalina, Vlasceanu Silviu Gabriel, Andrei Gabriela Marina, Riza Anca Lelia, Streata Ioana, Zlatian Ovidiu Mircea, Olteanu Mihai
Department of Pneumology, University of Medicine and Pharmacy, 200349 Craiova, Romania.
Department of Pneumology, Victor Babes University Hospital, 200515 Craiova, Romania.
J Clin Med. 2025 Jun 30;14(13):4633. doi: 10.3390/jcm14134633.
Chronic obstructive pulmonary disease (COPD) is an escalating global health burden, with a disproportionate impact on low- and middle-income countries (LMICs). Although tobacco smoking is a well-established risk factor, emerging evidence highlights the significant role of non-smoking exposure in driving the prevalence of COPD in these regions. This narrative review synthesizes current data on key non-smoking contributors, including household air pollution, ambient urban pollution, occupational exposure, early-life respiratory insults, chronic infections, and socioeconomic adversity. These risk factors are associated with distinct COPD phenotypes, often marked by increased airway inflammation, reduced emphysema, and variable airflow limitation. Such presentations are particularly common among women and younger populations in LMICs. However, diagnostic and therapeutic challenges persist, owing to limited disease awareness, under-resourced health systems, restricted access to essential medications, and financial constraints impacting adherence. Despite the proven effectiveness of non-pharmacological measures and public health interventions, their implementation remains inadequate because of infrastructural and funding limitations. Bridging these gaps requires region-specific clinical guidelines, improved diagnostic infrastructure, expanded access to affordable treatment, and culturally sensitive interventions. Future priorities include identifying robust biomarkers, refining disease definitions to accommodate non-smoking phenotypes, and advancing implementation science to improve interventions. A coordinated, context-aware global response is essential to reduce the growing burden of COPD in LMICs and to ensure equitable respiratory health outcomes.
慢性阻塞性肺疾病（COPD）是一个日益严重的全球健康负担，对低收入和中等收入国家（LMICs）的影响尤为严重。虽然吸烟是一个公认的风险因素，但新出现的证据凸显了非吸烟暴露在推动这些地区COPD患病率方面的重要作用。这篇叙述性综述综合了关于关键非吸烟因素的现有数据，包括家庭空气污染、城市环境污染、职业暴露、早年呼吸道损伤、慢性感染和社会经济逆境。这些风险因素与不同的COPD表型相关，其特征通常是气道炎症增加、肺气肿减轻和气流受限程度不一。这种表现形式在低收入和中等收入国家的女性和年轻人群中尤为常见。然而，由于疾病认知有限、卫生系统资源不足、基本药物获取受限以及影响依从性的经济限制，诊断和治疗挑战依然存在。尽管非药物措施和公共卫生干预措施已被证明有效，但由于基础设施和资金限制，其实施仍然不足。弥合这些差距需要针对特定区域的临床指南、改善诊断基础设施、扩大可负担治疗的获取途径以及开展具有文化敏感性的干预措施。未来的优先事项包括确定可靠的生物标志物、完善疾病定义以适应非吸烟表型，以及推进实施科学以改善干预措施。协调一致、因地制宜的全球应对措施对于减轻低收入和中等收入国家日益加重的COPD负担以及确保公平的呼吸健康结果至关重要。
