Clinico-Radiological Profile of Non-Smoker Chronic Obstructive Pulmonary Disease Patients at A Tertiary Care Hospital

Background: Chronic obstructive pulmonary disease (COPD) in non-smokers is increasingly recognised, particularly in developing countries, but remains under-characterised. Understanding clinico-radiological differences between smoker and non-smoker COPD is essential for optimal management. Objectives: To compare the clinical, radiological, spirometric, and laboratory profiles of smoker and non-smoker COPD patients attending a tertiary care hospital. Methods: This cross-sectional observational study was conducted in the Department of Respiratory Medicine, PGIMER & Capital Hospital, Bhubaneswar, from May 2023 to December 2024. A total of 271 COPD patients were enrolled, including 196 smokers and 75 non-smokers. Data on demographics, risk factor exposure, clinical features, dyspnoea severity (mMRC), exacerbations, hospitalisations, spirometry, laboratory parameters, radiological findings (chest X-ray and HRCT), and ECG were analysed. Statistical comparisons were performed using Student’s t-test and Chi-square test. Results: Non-smoker COPD patients were predominantly female, younger, and from lower socioeconomic strata, with significant exposure to biomass fuel, prior pulmonary tuberculosis, and asthma (p < 0.05). They had higher dyspnoea grades, more frequent exacerbations, and increased hospitalisations. Smoker COPD patients had significantly lower BMI, more severe airflow limitation, and emphysema-predominant changes on chest X-ray and HRCT (p < 0.001). Bronchiectasis and basal crackles were more common in non-smokers, while hyperinflation-related physical signs predominated in smokers. Conclusion: Non-smoker COPD represents a distinct phenotype with different risk factors, clinical presentation, and radiological patterns compared to smoker COPD. Recognition of these differences is crucial for early diagnosis, targeted prevention, and individualised management strategies.