Risk Factors Associated with Severe Exacerbation in Non-Smoking COPD Patients in Primary Care: A Retrospective Observational Study

Author(s):

Josep Montserrat Capdevila*, Pilar Vaqué Castilla, Jennyfer Jiménez Díaz, Joan Deniel-Rosanas, Araceli Fuentes Botargues, Eugeni Paredes Costa

Background: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide. While smoking is the main risk factor, a significant subset of COPD patients are non-smokers. The clinical features and exacerbation risk factors in this population remain understudied, especially in primary care. Objective: To identify risk factors associated with severe exacerbations in non-smoking patients with COPD in a real-world primary care cohort. Methods: We conducted a retrospective cohort study using anonymized data from 2,376 patients diagnosed with COPD in a Spanish primary care setting. Patients were classified according to their smoking status; only non-smokers (n=1,582) were included in the analysis. Severe exacerbation was defined as hospitalization or emergency department visits due to COPD worsening. We performed bivariate analyses and multivariate logistic regression to assess factors associated with exacerbations. Results: Among non-smokers, 113 (7.1%) experienced a severe exacerbation. These patients were significantly older (median 77 vs. 74 years; p=0.003) and had worse lung function (median FEV1: 1.37 vs. 1.70 L; p<0.001). Logistic regression identified atrial fibrillation (OR=2.04; 95% CI: 1.20 3.39; p=0.007) and bronchiectasis (OR=2.31; 95% CI: 1.42-3.68; p<0.001) as independent predictors of severe exacerbation. Conclusion: Among non-smoking COPD patients, older age, atrial fibrillation and bronchiectasis are significant risk factors for severe exacerbations. These findings highlight the need for personalized management strategies in non-smoking COPD populations in primary care.