Clinical outcomes of COPD associated with cigarette smoke, biomass smoke, and combined exposure: A retrospective observational study.
- 1Department of Respiratory Medicine, Faculty of Medicine, TOBB University of Economics and Technology, Ankara, Türkiye.
- 2Department of Respiratory Medicine, Başkent University Faculty of Medicine, Ankara, Türkiye.
Abstract
Introduction
Chronic obstructive pulmonary disease (COPD) related to combined exposure to cigarette and biomass smoke is insufficiently characterized. The aim of this study was to compare exacerbations and chronic respiratory failure (CRF) across smoking-associated, biomass-associated, and combined exposure COPD.Methods
In this retrospective, multicenter, observational study, 319 patients with stable COPD were classified into three groups based on exposure history: smoking-associated (n=159), biomass-associated (n=80), and combined cigarette and biomass exposure (n=80). Smoking and biomass exposure histories were retrospectively obtained from medical records. Cigarette exposure was quantified in pack-years, biomass exposure was assessed according to the documented type and duration of household fuel use, and patients with both exposures were classified as the combined-exposure group. Exacerbation frequency, CRF, and pulmonary function tests were evaluated. Multivariable models adjusted for age, sex, cardiac diseases, sarcopenia, and lung cancer were used to assess the associations of exposure group with annual exacerbation frequency and CRF.Results
Patients with combined exposure were younger (59.22 ± 10.82 years) compared with those in the smoking-associated (61.37 ± 11.04 years) and biomass-associated groups (63.45 ± 11.92 years, p=0.015). The combined exposure group had lower FEV₁ (% predicted: 48.27 ± 10.14 vs 55.28 ± 17.61 and 55.62 ± 11.29; p=0.003) and higher dyspnea scores (mMRC: 2.18 vs 1.39 and 1.88; p<0.001). Exacerbation burden was significantly greater in the combined exposure group, including higher annual exacerbation rates (2.18 ± 0.82 vs 2.08 ± 0.22 and 1.88 ± 0.32; p=0.041) and severe exacerbations (1.78 ± 0.35 vs 1.39 ± 0.18 and 1.20 ± 0.19; p<0.001). CRF was more frequent in the combined-exposure group (26.2% vs 17.0% and 11.2%; p=0.028). In adjusted analyses, combined exposure was independently associated with increased risk of severe exacerbations compared with cigarette smoking alone (AOR=1.89; 95% CI: 1.22-2.96).Conclusions
Findings of this study suggest that combined exposure to cigarette and biomass smoke is potentially associated with earlier COPD presentation, increased exacerbation frequency and lower FEV₁.
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BibTeX
@article{yuksel2026clinical,
title = {{Clinical outcomes of COPD associated with cigarette smoke, biomass smoke, and combined exposure: A retrospective observational study.}},
author = {Aycan Yüksel and Dorina Esendağlı and Polina Nezalzova and Gaye Ulubay},
journal = {Tobacco induced diseases},
year = {2026},
month = oct,
doi = {10.18332/tid/231161},
url = {https://europepmc.org/article/MED/42948714},
note = {CC BY},
}
RIS
TY - JOUR
TI - Clinical outcomes of COPD associated with cigarette smoke, biomass smoke, and combined exposure: A retrospective observational study.
AU - Aycan Yüksel
AU - Dorina Esendağlı
AU - Polina Nezalzova
AU - Gaye Ulubay
PY - 2026
DA - 2026/10/23
JO - Tobacco induced diseases
DO - 10.18332/tid/231161
UR - https://europepmc.org/article/MED/42948714
AB - Introduction Chronic obstructive pulmonary disease (COPD) related to combined exposure to cigarette and biomass smoke is insufficiently characterized. The aim of this study was to compare exacerbations and chronic respiratory failure (CRF) across smoking-associated, biomass-associated, and combined exposure COPD.Methods In this retrospective, multicenter, observational study, 319 patients with stable COPD were classified into three groups based on exposure history: smoking-associated (n=159), biomass-associated (n=80), and combined cigarette and biomass exposure (n=80). Smoking and biomass exposure histories were retrospectively obtained from medical records. Cigarette exposure was quantified in pack-years, biomass exposure was assessed according to the documented type and duration of household fuel use, and patients with both exposures were classified as the combined-exposure group. Exacerbation frequency, CRF, and pulmonary function tests were evaluated. Multivariable models adjusted for age, sex, cardiac diseases, sarcopenia, and lung cancer were used to assess the associations of exposure group with annual exacerbation frequency and CRF.Results Patients with combined exposure were younger (59.22 ± 10.82 years) compared with those in the smoking-associated (61.37 ± 11.04 years) and biomass-associated groups (63.45 ± 11.92 years, p=0.015). The combined exposure group had lower FEV₁ (% predicted: 48.27 ± 10.14 vs 55.28 ± 17.61 and 55.62 ± 11.29; p=0.003) and higher dyspnea scores (mMRC: 2.18 vs 1.39 and 1.88; p<0.001). Exacerbation burden was significantly greater in the combined exposure group, including higher annual exacerbation rates (2.18 ± 0.82 vs 2.08 ± 0.22 and 1.88 ± 0.32; p=0.041) and severe exacerbations (1.78 ± 0.35 vs 1.39 ± 0.18 and 1.20 ± 0.19; p<0.001). CRF was more frequent in the combined-exposure group (26.2% vs 17.0% and 11.2%; p=0.028). In adjusted analyses, combined exposure was independently associated with increased risk of severe exacerbations compared with cigarette smoking alone (AOR=1.89; 95% CI: 1.22-2.96).Conclusions Findings of this study suggest that combined exposure to cigarette and biomass smoke is potentially associated with earlier COPD presentation, increased exacerbation frequency and lower FEV₁.
SN - 2070-7266
SN - 1617-9625
ER -