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    COPET study findings regarding the clinical relevance of biomass exposure as an etiotype in COPD
    (Elsevier Science Inc, 2025) Ertan Yazar, Esra; Demirci, Nilgün; Arpınar Yiğitbaş, Burcu; Çalıkoğlu, Mukadder; Gülbaş, Gazi; Turan, Muzaffer Onur; Şahin, Hülya; Mirici, Nihal Arzu
    Purpose The finding that COPD can also develop in non-smokers has led to further investigations of etiologic causes other than smoking. This study evaluated the relationship between tobacco smoking and/or biomass-burning smoke exposure (BBS) and the demographic, clinical, and prognostic characteristics of individuals with COPD. Methods A total of 1129 stable COPD patients from the COPET study were retrospectively analyzed. The patients were divided into three groups: the COPD-B group ( n = 52), which included patients who were solely BBS; the COPD-C group ( n = 634), which included patients who exclusively tobacco smoking; and the COPD-BC group ( n = 443), which included patients with both BBS and tobacco smoking. Results The average age of the patients was 65.8 ± 9.1 years, and 87.4 % of them were men. In the COPD-B group, the following factors were significantly greater compared to the COPD-C and COPD-BC groups: age ( p = 0.001), BMI ( p = 0.001), percentage of female patients ( p < 0.001), FEV 1 /FVC ratio ( p = 0.014), eosinophil count ( p < 0.001), ADO score ( p < 0.001), and the proportion of patients with frequent exacerbations ( p = 0.013). Thorax CT scans showed that the COPD-BC group had a greater incidence of bronchiectasis and emphysema than the COPD-B and COPD-C groups ( p < 0.001). Conclusions This study highlights significant clinical and radiological differences among COPD patients based on tobacco smoking and BBS, which may substantially impact COPD outcomes, including exacerbations and prognosis.