Smoking patterns in African Americans and whites with advanced COPD

Background: The prevalence and mortality associated with COPD increases with age, with higher rates observed in whites than African, Americans. Causes and explanations for smoking-related. racial differences on the respiratory system have not been determined. Objective: To investigate racial differences in smoking patterns and lung function in patients with advanced COPD. Design: Retrospective record review of patients with advanced COPD. Setting: Outpatient pulmonary clinic in a tertiary-care urban hospital. Patients: One hundred sixty patients with advanced COPD (80, African Americans and 80 whites) referred for either lung volume reduction surgery or transplantation evaluation. Data collection: Demographics, smoking profile, pulmonary function testing, arterial blood gases, and exercise stress tests were compared between African-American and white patients. Results: Despite comparable pulmonary function, African Americans were younger at presentation and had lower overall pack-years of smoking than whites (58 +/- 10 years vs 62 +/- 8 years, and 44 +/- 23 pack-years vs 66 +/- 31 pack-years, respectively; p < 0.05 [mean +/- SD]). Additionally, African Americans started smoking later in life than whites (18 +/- 5 years vs 16 +/- 4 years). Similarly, women presented at a younger age and smoked less compared to men (58 +/- 9 years vs 62 +/- 9 years, and 49 +/- 28 pack-years vs 61 +/- 29 pack-years, respectively; p < 0.05), without showing any difference in lung function or exercise performance. Conclusion: Among susceptible patients with advanced COPD, African Americans and women seem more prone to the effects of tobacco smoke than their counterparts.